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Full text of "United States Navy Medical News Letter Vol. 45 No. 2, 29 January 1965"

NAVMED P-5088 




CONTENTS 
IMPORTANT— News Letter Renewal Notice Required 25 



MEDICAL ABSTRACTS 

Everyone Should be Concerned with Drug Safety 
Heat Illness and Related Problems 



FROM THE NOTE BOOK 

Correlation of Inheritance & Behavior with Brain 

Microanatomy 

Nurse Receives Superior Performance Award 

Slides, Films Available from AFIP 

Chloramphenicol-Fatal Aplastic Anemia 

Tri-Service Pediatric Seminar 

Management of Poisoning Cases 

DENTAL SECTION 

Oral Exfoliative Cytology as an Aid to Diagnosis 

Evaluation of Indirect Pulp-Capping Techniques 

Fluoridation News 

Retentive Properties of Dental Cements 

Personnel and Professional Notes 



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PREVENTIVE MEDICINE 

Vector Ecology & Integrated Control Procedures _. 

Coccidioidomycosis in Mexico 

Turtles as Source of Salmonellosis 

Vaccine Forecast for Chagas Disease 

Ear-Invading Beetles Active at Boy Scout Jamboree_ 

Summary — Influenza as of 2 Nov 64 

Snake Story 

National Association of Sanitarians 



RESERVE SECTION 

Clinical Congress of Abdominal Surgeons 
Check Your Own Service Record 



MISCELLANY 

Seminar on Leprosy for Military Dermatologists 

Indoctrination Tour for Interns 

Notice Concerning Wearing of the Uniform 

In Memoriam 



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United States Navy 
MEDICAL NEWS LETTER 



Vol. 45 



Friday, 29 January 1965 



No. 2 



Rear Admiral Edward C. Kenney MC USN 
Surgeon General 

Rear Admiral R. B. Brown MC USN 
Deputy Surgeon General 

Captain M. W. Arnold MC USN (Ret), Editor 
William A. Kline, Managing Editor 

Contributing Editors 

Aviation Medicine Captain C. E. Wilbur MC USN 

Dental Section Captain C. A. Ostrom DC USN 

Occupational Medicine CDR N. E. Rosenwinkel MC USN 

Preventive Medicine CDR J. H. Schulte MC USN 

Radiation Medicine CDR J. H. Schulte, MC USN 

Reserve Section Captain C. Cummings MC USNR 

Submarine Medicine CDR J. H. Schulte MC USN 



Policy 

The U.S. Navy Medical News Letter is basically an 
official Medical Department publication inviting the 
attention of officers of the Medical Department of the 
Regular Navy and Naval Reserve to timely up-to-date 
items of official and professional interest relative to 
medicine, dentistry, and allied sciences. The amount 
of information used is only that necessary to inform 
adequately officers of the Medical Department of the 
existence and source of such information. The items 
used are neither intended to be, nor are they, sus- 



ceptible to use by any officer as a substitute for any 
item or article in its original form. AH readers of the 
News Letter are urged to obtain the original of those 
items of particular interest to the individual. 

Change of Address 

Please forward changes of address for the News Letter 
to: Commanding Officer, U.S. Naval Medical School, 
National Naval Medical Center, Bethesda, Maryland 
20014, giving full name, rank, corps, and old and new 
addresses. 



FRONT COVER: The United States Naval Hospital, Portsmouth, Virginia, located on the Elizabeth River across 
from Norfolk, is the second largest naval hospital on the basis of patient load and clinical material available. 

The Portsmouth-Norfolk area is the home port of a large part of the Atlantic Fleet, of the Atlantic Air Wing, 
Amphibious Forces and Fleet Marine Force, Atlantic, with a resulting large population of Navy and Marine fam- 
ilies. The hospital serves as the support activity for these and other Armed Forces installations in the area, main- 
taining an average census of 1000 patients of all age groups, both sexes. 

The daily average occupied beds is 1,103. Special treatment facilities of the hospital include Thoracic Sur- 
gery, Plastic Surgery, Neurosurgery, Vascular Surgery, Deep X-ray, Radium, Oncology and Cardiopulmonary func- 
tion. 

The new 15 story, air-conditioned hospital building was commissioned on 22 April 1960. The original build- 
ing was the first naval hospital commissioned in (1827) and its history reflects that it was taken by the Confeder- 
ates on 20 April 1862 and retaken by the Union on 10 May 1862. Completely renovated between 1907 and 
1909, and temporary buildings added during World War II, it served until the new construction was completed 
in 1960. — Editor. 

The issuance of this publication approved by the Secretary of the Navy on 4 May 1964. 



U.S. NAVY MEDICAL NEWS LETTER 



EVERYONE SHOULD BE CONCERNED WITH DRUG SAFETY 

By Dale G. Friend MD, Journal of the American Pharmaceutical Assn., NS4(1I): 
528-530, November 1964. 



In any discussion concerning drug safety it is im- 
portant to stress at the very outset that there is no 
absolutely safe drug. Hazard in the use of drugs varies 
from a reaction which may occur once in 8,000 to 
10,000 patients to one which has an incidence of un- 
toward effects in as high as 50 percent or more of the 
patients receiving the drug. Society for the most part 
has justifiably become concerned with drug safety only 
in the past 25 years or less. Prior to this time there 
were few potent therapeutic agents available and these 
for the most part had been studied very carefully and 
were understood thoroughly by everybody handling 
them. Consequently, few untoward effects resulted 
from their use. 

Although considerable hysteria has been generated 
concerning drug safety, especially within the past two 
years following the thalidomide tragedy, there is never- 
theless sound ground for concern with drug safety on 
the part of everyone. After Osier and other medical 
and pharmaceutical leaders in the first decade of this 
century removed from the United States Pharmacopeia 
the many useless concoctions or weak acting agents 
which had been inherited from the previous century, 
a period of comparative therapeutic nihilism resulted. 

It is most certainly true that during the two decades 
following this, the people training physicians for the 
most part took a very dim view concerning the use of 
drugs in the treatment of disease. Much of this skepti- 
cism was justified since there were very few effective 
substances available. As a consequence therapeutics as 
such lost much of the importance it formerly held. 

During this time many departments of therapeutics 
and professors of therapeutics were dropped from 
medical schools. The activities formerly carried on by 
the professor of therapeutics were taken over by the 
new professor of pharmacology and clinical physicians. 
Therefore, the medical world for the most part was un- 
prepared for the therapeutic advances that were to 
come beginning with the sulfonamides in 1935 followed 
by penicillin and then a host of many agents for the 
treatment of many different medical conditions. These 
new agents were not only exceedingly potent materials 



* Presented at the joint special session of APhA, ASHP, NABP and 
Secretaries Conference at the annual meeting of the American 
Pharmaceutical Association in New York City, August 4, 1964. 



but often times were capable of bringing about con- 
siderable amelioration in the disease for which they 
were designed. Unfortunately, the advent of such potent 
substances for the most part found the medical pro- 
fession not equipped to handle and understand them 
as well as it might have been because of the previous 
period of therapeutic nihilism. 

During the first quarter of this century most iatro- 
genic disease resulted from surgical mishaps but with 
the release of numerous potent agents, iatrogenic disease 
became mainly a problem for the physician prescribing 
drugs. It is conservatively estimated that over a million 
so-called iatrogenic reactions occur each year. 

It is apparent that the tide of new synthetic prepara- 
tions is going to continue and may even become greater 
as chemists, pharmacists, physiologists, pharmacologists 
and physicians develop more information and skill in 
the field and devise better technics for screening and 
developing drugs. It is, therefore, imperative that we 
all become concerned with the safety of these agents 
which are now making such an impact on our society. 
At the present time drugs avaitable for use are divided 
into two categories — those which are made available 
only through the prescription of a physician and those 
agents which are available through over-the-counter 
purchases. 

Prescription Drugs 

The pharmaceutical industry at the present time with 
only minor exceptions, has developed a great deal of 
knowhow in the preparation of drugs so as to insure 
the stability, purity and reliability of their products. 
The excellent work done by the Food and Drug Ad- 
ministration to insure purity in food and drugs has 
borne fruit and no sensible manufacturer would release 
imperfect or impure agents for use. Furthermore, 
manufacturing controls have become much more effec- 
tive. The pharmaceutical industry can take great pride 
in its achievements in insuring that its products have the 
type of purity and stability needed for use in man. 

Once a new synthetic chemical has been purified and 
is in a form stable enough to be the same under all 
conditions necessary in a study, it is given to the 
pharmacologist, a highly trained scientist working in 



U.S. NAVY MEDICAL NEWS LETTER 



the pharmaceutical manufacturer's laboratory. He 
secures a vast amount of data concerning its pharma- 
cological action. By carrying on studies in several 
species of animals the pharmacologist obtains a great 
deal of information concerning action and toxicity. 
After this initial work has been done, the agent, if it 
shows sufficient promise, is submitted to the clinical 
investigator who then secures data concerning its action 
and toxicity in man. After it has been studied by the 
clinical investigator who, in a limited number of pa- 
tients finds it satisfactory for use in medicine, the drug 
is supplied to many physicians for further study and 
evaluation. 

After these investigators have completed their studies, 
this data, with the information obtained by the phar- 
maceutical manufacturer, is taken into consideration 
by the Food and Drug Administration. If the drug 
shows satisfactory efficacy, the question becomes one 
of determining its safety in reference to its therapeutic 
use. At the present time the scientific community is 
still working out methods of approach to this problem. 
For example, if a drug is effective but highly toxic, 
consideration must be given as to whether it has suffi- 
cient merit to release it for general use. Usually if 
the drug is effective and it may prolong or actually save, 
life in a situation where there are no other agents of 
equal effectiveness, then even a high degree of toxicity 
can be tolerated. However, if the drug is another in 
a long series of agents used for supportive treatment, 
such as the relief of pain, sedation or tranquilization, 
any degree of toxicity above what is already present 
in available drugs would lead scientists to feel that 
the drug probably has limited merit. 

Although the pharmacologist, clinical investigator and 
physicians studying the drug have secured a vast amount 
of information about it and usually have a good idea 
of its toxicity, there is always the possibility of some 
unsuspected toxic property occurring even after the 
drug has been released by the Food and Drug Admin- 
istration. It is, therefore, absolutely essential that 
physicians constantly be alert for such actions. 

The pharmacist also has an important role in this 
chain because once the physician writes a prescription 
order for the drug, the pharmacist generally is the last 
professional practitioner to have contact with the patient 
before the prescribed medication is consumed. Phar- 
macists from time immemorial have checked and re- 
checked to be sure that everything is exactly correct 
before a drug is dispensed. This last check is so essen- 
tial that no prescription drug should ever be given to a 
patient without having passed through the hands of a 
skilled pharmacist. 

Finally, the patient must co-operate if the maximum 
benefit with the minimum amount of danger is to be 
secured from the medication used. Instructions written 
by the physician should be explicit and the patient 



should know of possible hazards. Certainly patients 
should be warned to inform their physician or pharma- 
cist of the slightest indication of anything unusual about 
the drug's action in the treatment of their condition. 
Unfortunately in our modern society at this stage our 
carefully designed chain of information often breaks 
down. In a study made several years ago on patients 
receiving medicines from the out-patient department 
of the Peter Bent Brigham hospital, it was found that 
approximately 50 percent exhibited some error in their 
medication, although physicians were confident that 
the patients had been instructed properly and they 
were doing as directed. It was indeed a shock to all 
concerned to find patients eating suppositories, taking 
medicines in the wrong manner, confusing their medi- 
cines entirely or using drugs that had been prescribed 
previously. 

There are certain rules that I have made a principle 
of using in my practice of medicine to promote the 
highest degree of safety. First, I never prescribe a drug 
unless it is absolutely needed. Second, I continue the 
drug only long enough to secure the therapeutic effect 
desired and stop it as soon as possible. The continua- 
tion of any medication over long periods of time in- 
creases the hazards of a drug reaction. Whenever pos- 
sible, mixtures of drugs are avoided because often- 
times these preparations lead to complications when 
reactions occur since no one knows exactly what drug 
is causing the trouble. Furthermore, it is often im- 
possible to treat the patient intelligently and skillfully 
if three or more ingredients are involved in the titration 
of the dose to the patient's need. 

Patients are warned to report immediately any un- 
usuaT happenings during the time they are taking the 
drug and their responses to the drug are followed close- 
ly during the adjustment of the dosage in order that any 
early toxic signs can be detected promptly and harm 
prevented. The label affixed to the container of pre- 
scribed medication provides precise instructions but 
whenever complicated instructions make such labeling 
impossible, the prescriber writes out these instructions 
on separate prescription blanks so that the patient can 
refer to them as needed to refresh his memory. 

It is imperative in modern-day usage of potent drugs 
that patients thoroughly understand instructions phy- 
sicians are giving to them. Providing such understand- 
ing takes time and effort on the part of the physician 
but it can be richly rewarding. The name of the drug 
should be given to the patient by the prescriber and 
all medication thus prescribed should contain the name 
of the agent, the dose and instructions on the container. 
The amount of drug prescribed should be restricted to 
the needs of the patient for a short term interval since 
over-prescribing is not only costly to the patient in that 
he pays for drugs he does not use, but also hazardous 
to him and his family in that the excess remains in 



U.S. NAVY MEDICAL NEWS LETTER 



the medicine cabinet. Oftentimes a patient may con- 
sider that since a drug, which helped him under certain 
circumstances is available, it can be used to help him 
under new circumstances. 

Over-the-counter drugs 

Over-the-counter drugs are agents which have been 
deemed of sufficient general value and of such limited 
degree of toxicity that they can be made available for 
direct purchase by a patient. This class of drugs sup- 
plies an important human need because all mankind 
deems it an inherent right to take medicines on his own 
initiative. That this urge has existed from ancient time 
has been proved in innumerable situations. Up until 
about the turn of this century such self-medication 
led to very little harm since most concoctions consisted 
of various types of herbs with very limited or no phar- 
macological action. However the advent of synthetic 
preparations such as the analgesics, sedatives and more 
recently the antihistamines and sympathomimetic amines 
has placed in the hands of the layman many potent 
and at times toxic substances for self -medication. 

Unquestionably there is far more self-medication now 
than ever existed in our grandparents' day and, as a 
consequence, a great deal more toxicity is also occur- 
ring, much of which does not reach the medical litera- 
ture or is very ill-understood even by physicians them- 
selves. Any wise physician who has good knowledge 
of drug action knows that patients taking antihistamines 
get skin reactions, abnormal cardiac action, over-seda- 
tion and at times mental excitement. Toxic effects are 
being observed with many of the commonly used 
analgesics, anticold preparations and numerous other 
over-the-counter remedies. Formerly when these agents 
were sold in the pharmacy only, the pharmacist, a 
highly trained scientist who knew drug action and who 
quite frequently knew and oftentimes was on very 
friendly terms with those who procured drugs from 
him, was able to warn the individual. In this way the 
pharmacist exerted a potent public health action in 
preventing or ameliorating the toxic effects to drugs. 
This safety control unfortunately was lost when many 



of these over-the-counter preparations were placed in 
supermarkets, restaurants and other places where indi- 
viduals could purchase them without any possibility 
of receiving expert advice. In view of the present trend 
of widespread advertising urging the public to self- 
medication, it may well be necessary in the public 
health interest to exert a much more stringent selection 
of drugs released for complete and uncontrolled use by 
the lay public. 

There has always existed many inherent dangers in 
self-medication. Physicians are all aware of the hazards 
of such practices whereby the real diagnosis of disease 
is delayed or its symptoms are masked until serious 
progression has taken place which may lead to the 
individual's losing his life. However, the medical world 
has long recognized that it is impossible to control this 
fundamental urge of ail people to dose themselves with 
many different types of concoctions and therefore they 
have taken the position that everything should be done 
to protect the individual from himself. 

It may be necessary as has been suggested by certain 
pharmaceutical groups to define and recognize different 
categories of drugs. For example, the usual prescription 
item under very careful control of the physician and 
pharmacist would remain in its present status. For 
drugs in which certain toxic properties and possibilities 
for harm exist to a low degree, an intermediate group 
would be established which could be obtained only in 
pharmacies where a highly trained pharmacist with a 
definite knowledge of the drug's action and its possible 
toxic effects could release the drug directly to the 
public. Finally, a third category of comparatively 
harmless substances would be indicated which could be 
sold in supermarkets, restaurants and other places. 

In conclusion, drug safety is everyone's business — 
the manufacturer, Food and Drug Administration, phy- 
sician, pharmacist and public in general. The more 
sensible information we can make available to the 
public concerning a drug's toxicity and methods to 
overcome it, the better. 

Copyright 1964, American Pharmaceutical Assn., 2215 Constitu- 
tion Ave., N. W., Washington, D. C. 20037. 



PREVENTION OF MENTAL ILLNESS 

A seminar on public health practice and the preven- 
tion of mental illness was held in London from 6 to 17 
July 1964 by the WHO Regional Office for Europe, in 
cooperation with the Government of the United King- 
dom. It discussed the role of the public health and 
mental health services in the prevention of mental dis- 
orders, with special emphasis on services administered 
and operated by public health personnel, including 



maternal and child health centres, school and university 
health services, and services for the elderly. The theory 
and practice of general preventive measures, including 
the health education of the public with regard to mental 
health and the preventive role of the visiting nurse, were 
also reviewed. 

The participants in the seminar included public health 
administrators, general practitioners, paedriatricians, 
public health nurses, and mental health staff. — WHO 
Chronicle 18(8): 3 1 0, August 1 964. 



U.S. NAVY MEDICAL NEWS LETTER 






HEAT ILLNESS AND RELATED PROBLEMS 



* 



A. W. El Halawani MD, Saudi Arabia, World Health Organization, WHO Chronicle 
18(8): 288-298, August 1964. 



THE PREVENTION OF HEAT DISORDERS 

Although much more research is required before 
our understanding of the heat disorders is optimal, the 
practical application of existing knowledge can greatly 
reduce the incidence of the heat disorders in any previ- 
ously uncontrolled situation. The basic approach is to 
some extent dictated by the circumstances in question; 
for example, it is usual to limit human activities in 
outdoor heat, and to adjust indoor environments to 
within the limits of safety even for strenuous work or 
exercise. If an indoor (usually industrial) environment 
cannot be modified in this way, then it is necessary 
to limit the rate or duration of work or to provide those 
concerned with suitable insulation, barrier shields 
against radiant heat, ventilated suits, or similar forms of 
protection. Cool and well-ventilated resting quarters, 
and an adequate supply of palatable drinking fluids 
are immensely important. However, a real attempt to 
make people limit their activities in daily peak heat 
periods is always desirable. 

The first step is to identify the circumstances in which 
the heat disorders are known or can be expected to 
occur, and to gather the climatic data concerned in a 
way that makes possible the application of one or other 
of the arbitrary indices of heat stress. Procedure there- 
after is best illustrated by the use of the WBGT index 
in reducing the incidence of heat casualties among 
US Marine recruits at Parris Island. A yellow flag 
was raised when the WBGT index reached or exceeded 
85, and indicated that drill or other strenuous activities 
should be discontinued by recruits or reserve trainees 
in their first two weeks of training; a red flag, hoisted 
when the WBGT index reached or exceeded 88, indi- 
cated cessation of drill and other strenuous activities 
by all trainees, regardless of their state of acclimatiza- 
tion. In addition, the breaking-in of new recruits was 
accomplished by graduated intensity of physical con- 
ditioning exercises during the first week and thereafter, 
and by limiting infantry drill to one and a quarter hours 
per day for the first week, with five-minute breaks 



after each 30 minutes of drill. After the first week as 
many as four hours of drill per day were permitted. 
These regulations brought a significant reduction in 
heat casualties from the summer of 1955 to the summer 
of 1956, despite the fact that in 1956 the climatic con- 
ditions were more severe and many more hours were 
spent at drill. It would be difficult to implement gradu- 
ated intensity of physical effort by Mecca pilgrims 
during their acclimatization period; but the use of a 
flag as described previously, combined with appropriate 
advice on Pilgrimage activities in relation to location, 
acclimatization, and age, seems worth trying. 

Although it has been admitted that generalizations 
about water and salt requirements in hot surroundings 
are hazardous, informed assumptions are in practice 
often desirable and occasionally unavoidable. Fluid 
requirements are such as will prevent or alleviate thirst, 
protect therefore against clinically significant water- 
depletion, and maintain — whatever the circumstances — 
an individual daily (24-hour) urine output of not less 
than 600 ml. Provided that the population at risk is 
of fairly uniform composition and habits, it is possible 
to derive a reasonably accurate estimate of the re- 
quirements, if the sweat losses due to various activities 
are measured in a sample group at different periods of 
the day; but in a mass gathering such as the Mecca 
Pilgrimage, a more realistic approach would be to check 
fluid intakes against urine outputs in representative 
groups of travelers. Owing to the practical difficulties 
of such an investigation, it might be preferable to 
assume that at least eight litres per head of potable fluid 
daily will be needed. It should be borne in mind that 
this figure is not related to the needs of one or other 
specific individual, is intended to allow for the health 
of unacclimatized personnel even in severe outdoor 
heat, and has nothing to do with requirements for 
survival. It is also worth making the point that pilgrims 
who are accustomed by necessity to a very much 
smaller intake and respond to an abundance of potable 
fluids by drinking large quantities may be liable to 
sodium depletion. 



U.S. NAVY MEDICAL NEWS LETTER 



It is significant that the Saudi Arabian Government 
has provided not only water at frequent intervals along 
the routes followed by the pilgrims, but also chilled 
water in the situations where heat casualties are preva- 
lent, for fluids must be palatably cool if they are to 
be taken in quantities sufficient to combat voluntary 
dehydration. In an interesting field experiment in Israel 
one August — discussed in the technical discussions at 
the twelfth session of the WHO Regional Committee 
for the Eastern Mediterranean — a large variety of 
chilled and unchilled drinks, including water, milk, 
lemonade, and beer, were offered to soldiers marching 
27 km daily for 24 days, carrying individual packs 
weighing 16 kg. The men preferred citrus-flavoured 
water at a temperature of 10°C to 15°C (50°F to 
59°F), and drank this in amounts adequate to replace 
sweat losses of 5-10 litres daily. 

According to current knowledge, unacclimatized men 
who have a short-term and specific job to do almost 
from the moment of entry into hot countries may re- 
quire initially a total salt intake of 15-20 g daily, 
depending on their previous salt intake, the amount of 
exercise undertaken, and the degrees of climatic heat 
prevailing. This would mean daily supplements of 5- 
10 g of salt to a European-style diet, with a gradual 
reduction to preheat levels of intake over the course of 
the first three weeks or so in the heat. The accustomed 
daily level of salt intake should be selectively main- 
tained if food intake is reduced by short supply or loss 
of appetite; and extra salt is required in the presence of 
diarrhoea. Finally, no extra salt should be taken 
when water is in short supply. The recommendation 
of an initial salt intake of 15-20 g is not applicable to 
Mecca pilgrims, however, unless salt depletion is known 
to be one of the heat disorders encountered on the 
Pilgrimage. In cases of known salt depletion, the 
practical issue arises of how those concerned can best 
take the extra salt. Bread, soup, and tomato juice are 
good vehicles, and drinking water remains palatable to 
most people when it contains sodium chloride in a 
concentration of 500 to 1000 parts per million (ppm); 
some desert Arabs tolerate brackish water containing 
salt in concentrations up to 8000 ppm. Salt tablets 
should be avoided if possible, since there is a tendency 
to attribute almost mystic properties to them, and this 
can be harmful as well as beneficial. If they must be 
used, enteric sugar-coated tablets containing 0.65 g of 
salt are as good as any, for they are big enough to 
limit the number of tablets required, without being too 
big to dissolve and are therefore passed through largely 
unchanged in diarrhoea. 

Protection against radiant heat from the sun is of 
considerable importance to the Mecca pilgrims, so the 
decisions to provide the path round the Kaaba with a 
canvas canopy and to shade the Masaa are of value. 
The heat by radiation from full sunlight may be as 
much as 250 kcal/h, but white clothing will reflect the 



energy of the shorter wavelengths and thereby reduce 
the solar heat load by as much as 50%, and the provi- 
sion of a canopy with a sufficiently high space over- 
head to allow free ventilation (to avoid an increase in 
air temperature) can reduce the remaining solar heat 
load to relatively small proportions. Inadequate ventila- 
tion is presumably the main reason why temperatures 
inside tents in Mena and Arafat were 5°C higher than 
in open shade near by. It is immensely important that 
plans for the housing of pilgrims in Mecca, presumably 
(for financial reasons) in buildings without air-cooling 
systems, be soundly based on modern concepts of 
architectural bioclimatology. This aspect of hot-climate 
housing has received increasing attention in the build- 
ing research stations in Durban, Watford (England), 
and elsewhere, and in the School of Public Health and 
Tropical Medicine in Sydney. Much can be done to 
limit indoor temperatures by making the best possible 
use of natural ventilation, and by providing external 
reflective or absorptive shields against solar radiation. 
Temperatures can be reduced even inside motor cars 
or buses if their roofs are painted white. 

The remaining approach, in circumstances in which 
protection can at best be incomplete and the applica- 
tion of a heat stress index to the control of strenuous 
activities unsatisfactory, is to take all possible steps to 
tell the people concerned how to behave in high sur- 
rounding temperatures. A former chief medical officer 
of the Kuwait Oil Co. successfully used this method for 
ship's crews at Mina-al-Ahmadi; pamphlets on the sub- 
ject in several different languages were issued each 
summer to seamen arriving at the port, and a short 
documentary film was recently produced for showing 
in a recreation hall on the pier. For travellers to Mecca, 
coloured posters along the lines adopted by the medical 
department of the Arabian-American Oil Co. and 
radio commentaries on the subject seem suitable addi- 
tions to pamphlets. 

SOME ASPECTS OF HEAT STROKE 
TREATMENT 

It seems likely that, even when all possible control 
measures have been adopted, heat illness in any natur- 
ally hot climate will have been reduced but not eradi- 
cated. Therefore, wherever the disorders are known to 
occur, there should be efficient facilities for the speedy 
reception and treatment of patients. Patients with any 
of the known heat disorders benefit by being placed 
in a cool environment, and therefore field clinics, 
ambulances, and hospital reception and treatment 
rooms should all be supplied with air-cooling units. 
Treatment centers should also be strategically placed, 
These comments are particularly relevant to heat stroke, 
for if patients suffering from this disorder can be 
properly received within minutes or at most an hour 
of their collapse treatment is relatively easy and the 



U.S. NAVY MEDICAL NEWS LETTER 



prognosis is good. On the other hand, no amount of 
equipment, experience, or skill can keep down the 
death rate in patients who have been in hyperpyrexia 
and coma for several hours before reaching medical aid. 

A method of effective cooling should be employed 
immediately after a diagnosis of heat stroke has been 
made. Cooling is effective if the rectal temperature is 
reduced to 38.9°C (102°F) within one hour, regardless 
of the degree of hyperpyrexia present at the outset. 
This does not imply that effective cooling always saves 
the patient, or that less rapid cooling is incompatible 
with survival; the time schedule is simply one that 
experience has shown to be desirable. There is some 
controversy over the methods by which such rapid 
cooling can be achieved. There are really only two 
ways of doing it. The first is to use the slatted heat 
stroke treatment table designed in Kuwait and now 
coming into wider use in the Eastern Mediterranean 
Region; the stripped, unconscious patient is laid on the 
table and sprayed from above and below with water 
chilled to about 7°C (44.6°F); the room in which the 
table is housed is air-conditioned and supplied with 
powerful fans so that the patient is exposed to a cur- 
rent of dry air. Cooling, which is by convection and 
evaporation, is stopped when the rectal temperature 
reaches 38.9°C (I02°F). The second method, fa- 
voured for many years in the USA, is to place the 
stripped and unconscious patient in a tub or bath filled 
with ice chips and water and massage the limbs and 
trunk throughout cooling; the patient is transferred to 
bed in a cool room when the rectal temperature has 
reached 38.9°C (102°F). 

A criticism commonly directed at these methods, 
and particularly at the first, is that they require facili- 
ties not readily available in the circumstances in which 
heat stroke may occur. The only reason why they 
should not be available in climatic conditions where the 
hazard is constant is a financial one. It is of course 
more difficult to provide chilled water and air-condi- 
tioned treatment rooms for itinerant communities, but 
by incorporating all the facilities of the heat stroke 
treatment table in a caravan trailer the Bahrein Petro- 
leum Co. have shown that it is possible. If heat stroke 
occurs in an unexpected situation and in the absence 
of prepared facilities, then the most valuable method 
of cooling is to wrap the patient in a wet sheet and to 
provide as much air movement as possible to promote 
evaporative heat loss; but according to the recorded 
experience of two groups of observers there is no ques- 
tion of this technique being as good as the ice bath 
in terms of rapidity of cooling. A more fundamental 
criticism is that by employing ice, or nearly ice-cold 
water, the first two methods cause peripheral vaso- 
constriction and shivering and struggling even in heat 
stroke patients; and since these responses impede cool- 
ing they are regarded by some authorities as serious 
disadvantages. More significantly still, it is argued that 



placing the patient in a medium close to freezing point 
might result in a dangerous state of shock. 

The essence of the question is therefore whether or 
not rapid cooling, by however drastic a method, offers 
a better prognosis than does the clearly innocuous and 
less dramatic wet-sheet and tepid-sponging techniques; 
and the evidence is that it does. Medical shock does 
not appear to follow the application of ice or ice-cold 
water to unconscious and hyperpyrexic patients, pro- 
vided that cooling is stopped before the rectal tempera- 
ture falls below 38.9°C (102°F) or thereabouts. 
Vaso-constriction and shivering do not in practice 
interfere with rapid cooling to any significant degree; 
and in any case they may be countered to some extent 
by the prior administration of chlorpromazine, which 
is now of established value in the treatment of heat 
stroke. Clinical experience might justifiably be criticized 
as being not sufficiently objective, particularly in view 
of the urgent life-or-death nature of the disorder. One 
experiment has been attempted in order to settle the 
problem, and naturally it was performed within the 
limits of human safety; the subjects were therefore 
neither anhidrotic nor comatose and rectal tempera- 
tures did not exceed 40.2°C (104.4°F), so that unfor- 
tunately there is no reason to believe that the results of 
the different methods of cooling employed have any 
relevance to the treatment of heat stroke. It remains 
to say that the question has been raised recently of 
whether chlorpromazine might serve, not as an adjunct 
to cooling, but in place of it. One case of heat stroke 
has been reported in which chlorpromazine and 
dipyrone (drugs with synergist hypothermic actions) 
were used successfully without concomitant cryo- 
therapy; however, since the treatment included the 
application of wet towels and intermittent sponging 
with tap water, and since the patient concerned was 
received within minutes of collapse and the recogni- 
tion of hyperpyrexia, judgment on this particular issue 
must be deferred. 

Not for well over a decade will the Mecca Pilgrimage 
again coincide with the fierce summer temperatures of 
the area and therefore with the highest local morbidity 
and mortality rates for heat illness. This should be 
taken as an opportunity for methodical study of the 
problems concerned and not for procrastination. The 
pressing needs appear to be for strategically placed 
biochemicalandclimatological units by which the types 
of heat disorder that occur and the environmental con- 
ditions concerned are all precisely identified. An op- 
portunity exists of testing the applicability to the situa- 
tion of one or other of the arbitrary indices of heat 
stress, and possibly also of defining the incidence of the 
heat disorders in terms of a new scale. 

Research is required, especially into the pathogenesis 
of heat stroke, prickly heat, and anhidrotic heat exhaus- 
tion (if the latter disorder affects pilgrims). The 
anhidrosis of heat stroke requires re-examination and 



U.S. NAVY MEDICAL NEWS LETTER 



proper definition. Knowledge of water and electrolyte 
balance in conditions involving exposure to heat is less 
than in many other medical conditions, particularly 
with regard to potassium metabolism and requirements. 
The diverse origins and composition of the pilgrims, 
their enormous numbers, the procedures with which 
they all comply and the environmental conditions to 
which they are all exposed, afford a unique opportunity 



for studying the influence of factors such as age, race, 
and sex on thermoregulation and the incidence of heat 
casualties. For that matter, the pattern of heat illness 
in outdoor climates has never been followed by any one 
group of observers for more than two or three consecu- 
tive seasons. 



* Continued from Volume 45, No. 
third and final installment. 



1, 15 January 1965, This is the 



FROM THE NOTE BOOK 



Navy Studies Correlation of Inheritance and Behavior 
With Brain Microanatomy. Dr. Jose Delgado, who has 
been studying neurophysiological mechanisms on con- 
tract for the Office of Naval Research, particularly 
as related to behavior and drug action, has been col- 
laborating on studies at Madrid University and Cajal 
Institute of Neuroanatomy, Spain. Because of his 
techniques for stimulating emotional responses in 
animals by broadcasting signals to electrodes implanted 
in various parts of the animal's brain, Dr. Delgado 
attracted the interest of the scientific community. 

One collaborative study deals with the neurophysio- 
logical basis for the inheritance of aggressive behavior. 
The study is being concluded on a strain of "brave" 
bulls especially bred for bullfights. Using his special 
radio telemetry system, Dr. Delgado and his colleagues 
have been able to stop a "brave" bull charging at full 
speed in a bull ring almost instantaneously in his 
tracks by stimulating a specific area of the brain. 
Further, the bull lost his aggressive characteristics. Dr. 
Delgado's responsibilities in this study involve the cor- 
relation of behavior with the specific microscopic 
anatomy of the brain area that was stimulated. He 
hopes to apply these techniques of telemetered brain 
stimulation to the treatment of humans suffering from 
brain diseases such as epilepsy. — From Office of Naval 
Research, Washington, D. C. 

NURSE RECEIVES SUPERIOR PER- 
FORMANCE AWARD 

The first Sustained Superior Performance Award 
to be granted to a Civil Service Employee at the U.S. 
Naval Auxiliary Air Station, Meridian, Miss., has been 
presented to Mrs. Vivian Lightsey, Registered Nurse 
attached to the station's medical department. The 
award, in the form of a check, was presented by the 



Commanding Officer, CAPT J. W. Williams, Jr., on the 
recommendation of the Senior Medical Officer, CAPT 
Howard W. Hill, with the approval of the Civil Service 
Rating Board. 

Mrs. Lightsey has been assigned to the dependents' 
patient clinic at the air station since November 13, 
1961, and has been the only nurse assigned since 
November, 1963. This clinic is visited by approxi- 
mately 10,000 outpatients per year in addition to all 
immunizations given to the local service community. 

Mrs. Lightsey is a resident of Daleville, Miss., and 
has held nursing positions in both Lauderdale and 
Kemper Counties in Mississippi. — From Service In- 
formation Office, NAAS, Meridian, Miss., 18 Nov 
1964. 

SLIDES, FILMS AVAILABLE 

The following slide sets are available on a two-week 
loan basis to MILITARY or FEDERAL agency per- 
sonnel, from the Medical Illustration Service, Armed 
Forces Institute of Pathology. 

The Coombs Test, Part I — Clinical Medicine, con- 
sisting of 51 lantern slides, with 4 sets available for loan. 

L-6864 Malacoplakia of the Urinary Tract, con- 
sisting of 50 lanterna slides, with 5 sets available for 
loan. 

The following films were recently included in the 
AFIP Audio-Visual Communication Center, 

AFIP-150 Epidemic of Histoplasmosis, 
color, 17 min. 

PMF 5381 Temporary Plastic Bridge, col- 
or, 19 min. 

MF 8-5104 The Larynx and Voice-Physi- 
ology of the Larynx Under 
Daily Stress, Color, 24 min. 



U.S. NAVY MEDICAL NEWS LETTER 



MF 8-5105 The Larynx and Voice— The 
Function of the Normal 
Larynx, color, 22 min. 

AFIP-151 Modern Tissue Processing, col- 
or, 24 min. 



CHLORAMPHENICOL 

Fatal Aplastic Anemia 

Republished from CLIN-ALERT®, No. 326, Nov 19, 
1964, by permission of Science Editors, Inc. 

An epidemiological study was carried out at the re- 
quest of the California State Legislature because of 
concern with potential hazards to the public health 
from chloramphenicol (Chloromycetin) and other anti- 
biotic drugs. The study cases consisted essentially of 
all reported deaths (183) from aplastic anemia or 
pancytopenia recorded during the period January 1957- 
June 1961. Antimicrobial drugs had been given to 42 
persons, most of whom were in the "aplastic anemia" 
study category. More persons (30) received chlor- 
amphenicol than received alt other antimicrobial drugs 
combined (28). Half of the persons who received 
chloramphenicol had also received another antimi- 
crobial drug, for the most part not known to be toxic to 
bone marrow. A significant statistical correlation was 
found between chloramphenicol sales volume (sales 
data provided by Parke, Davis & Co.) and the number 
of reported deaths from aplastic anemia. The 30 
fatal cases with a history of chloramphenicol exposure 
differed epidemiologically from 108 study deaths with- 
out record of chloramphenicol exposure: (a) the 
chloramphenicol exposed group was younger than the 
remainder of the study sample; (b) the average time 
between clinical onset of blood dyscrasia and death was 
shorter among those exposed to chloramphenicol than 
among those not exposed; (c) there was a concentration 
of cases with clinical onset of symptoms in the months 
of April and May among persons exposed to chloram- 
phenicol. There was no such concentration at any 
particular time of year among persons not exposed to 
the antibiotic. The risk of fatal aplastic anemia in 
persons receiving chloramphenicol is at least 1:60,000 
— probably much greater. The study revealed that in 
many cases chloramphenicol had been used injudi- 
ciously for conditions in which another antibiotic 
would have been just as effective. Chloramphenicol was 
rarely used according to the criteria recommended by 
the AMA's Council on Drugs, the Am Acad Pediatrics, 
the FDA, and many eminent medical authorities. 
Chloramphenicol must be used judiciously because 
periodic blood counts can not be relied upon to detect 
signs of bone marrow toxicity before irreversible 
aplastic anemia develops. Judicious use prohibits 
chloramphenicol for prophylaxis, for trivial infections, 



and for infections in which a less dangerous drug may 
he equally effective. — Smick et al (Calif State Dept 
Public Health), J. Chronic Dis 17: 899, October 1964. 



TRI-SERV1CE PEDIATRIC SEMINAR 

The first Tri-Service Pediatric Seminar will be held 
at Walter Reed General Hospital, Washington, D.C. on 
3-5 March 1965, under the direction of COL John P. 
Fairchild, Chief of Pediatrics. 

All pediatricians and residents in this specialty on 
active duty are eligible to attend. A limited number of 
officers can be authorized to attend the seminar on 
travel and per diem orders chargeable against BuMed 
funds. Officers who cannot be provided with travel 
orders to attend at Navy expense will be issued 
Authorization Orders by their commanding officers 
following confirmation by this Bureau that space is 
available. Requests should be forwarded via chain of 
command in accordance with BUMEDINST 1 520. 8 A 
NOTE: The deadline for receipt of requests in this 
Bureau is 1 February 1965. 



MANAGEMENT OF POISONING CASES 

In an effort to reduce the toll of disability and death 
from ingestion of poisons, all medical personnel who 
may be called upon to make immediate decisions with 
regard to the management of poisoning cases are 
urged to be thoroughly familiar with the basic principles 
of treatment of the more common poisons. 

The commonest situation is that of the arrival of a 
two or three year old child in an emergency room, ac- 
companied by a distraught and guilt-ridden parent, 
shortly after ingestion of an (often) unknown amount 
of an (often) unknown substance. Since rapid and 
effective treatment is the essential feature of the 
management of acute poisoning, skill, confidence and 
resourcefulness are prerequisites in those who have to 
deal with this most serious of emergencies. Attention 
is invited to the following points: 

1. Since specific treatment depends on knowledge of 
the type of poison (rather than the amount), every- 
thing possible should be done to ascertain this. It 
should be remembered that a sample of an ingested 
poison is almost always available — the gastric contents. 

2. For poisons ingested within eight hours, the 
stomach must be washed out, whether vomiting has 
occurred or not, unless strong acids or alkalies are 
involved. 

3. The tendency to assume that there is no danger 
if the patient appears normal should be resisted unless 
it is absolutely certain that the amount is essentially 
harmless. Many of those who have died looked well 
right after ingestion of the poison. 



U.S. NAVY MEDICAL NEWS LETTER 



4. When in doubt, lavage immediately. It is better 
to do this one hundred times when not necessary than 
to miss one case when it is lifesaving. 

5. All responsible personnel should be cognizant of 



the local sources of information about poisons, whether 
the local Poison Control Center, local toxicology or 
chemistry laboratories, or available textbooks. — Sub- 
mitted by CDR F. J. Linehan MC USN, Code 311, 
BUMED. 




DENTAL SECTION 



ORAL EXFOLIATIVE CYTOLOGY AS AN 
AID TO DIAGNOSIS 

H.D, Millard DDS MS, University of Michigan, Ann 
Arbor, Michigan. JADA 69(5): 547—550, November 
1964. 

The purpose of this paper is to examine the tech- 
nique of oral exfoliative cytology from the point of view 
of neither the oral pathologist nor the cytologist, but 
from the point of view of the teacher of oral diagnosis 
who must deal mainly with the results of the technic. 
The teacher of oral diagnosis must decide what em- 
phasis to place on oral cytology in comparison to 
the technic of biopsy. At all times he must weigh the 
value of the procedure, not from the standpoint of its 
simplicity, but from the standpoint of the assistance 
the procedure lends to making an accurate diagnosis. 

In a practical sense, oral cytology may have some 
important side effects on the diagnosis of oral disease. 
If it accomplishes nothing more than to encourage a 
thorough examination of oral soft tissues on a wide- 
spread basis, it would serve an extremely useful pur- 
pose. Oral cytology may contribute a great deal to 
making a diagnosis in certain specific situations. When 
there are observed mucosal changes in which the oral 
mucosa shows widespread involvement rendering biopsy 
of the region impractical, perhaps a combination of 
biopsy of clinically representative regions and cytologic 
examination of the remainder of the large area of 
change would be helpful in evaluating the entire lesion. 
Cytologic examination is useful in patients in whom 
biopsy is contraindicated, such as in patients who have 
systemic disease involving hemorrhagic risks or reduced 
resistence to infection. Perhaps the most important 
aspect of oral cytology will turn out to be the fact that 
it provides a simple, painless, bloodless way for dentists 
to examine lesions about which they now do nothing 



until the lesions get so large that they can no longer be 
ignored. 

The limitations of oral cytology are several. Most 
important is that it only reveals if a lesion is or is 
not carcinoma. It is important to rule out cancer as a 
possible diagnosis, but at the same time it is important 
to determine the specific nature of the tissue change 
when it is not carcinoma. Oral cytology provides identi- 
fication of only a few specific tissue changes other than 
those of cancer. Cytology does not give any notion of 
extent of invasion, nor does it identify the degree of 
differentiation of carcinoma of the oral mucosa. 
Another limitation is the reliability of the technic of 
cytology as it is based on current information. 

The proponents of the oral cytologic technic em- 
phasize that the technic is not a substitute for biopsy 
but should be used only as an adjunct to the biopsy 
in the diagnosis of oral cancer. 

EVALUATION OF INDIRECT PULP-CAPPING 
TECHNIQUES 

B, C. Kerkhove Jr., S. C. Herman, and R. E. Mc- 
Donald, Indiana University School of Dentistry, In- 
dianapolis, J D Res 43(5)Part II: 807-808, Sep-Oct 
1964. 

The study was designed to provide information re- 
garding the effectiveness of two materials — calcium 
hydroxide and zinc oxide and eugenol, when used as 
agents to cover residual caries in deciduous and perma- 
nent teeth for periods of time up to one year. Changes 
in the dentin and the pulp beneath the pulp-capping 
agents were also evaluated. Eighty-seven teeth including 
21 mandibular first prmanent molars and 42 second 
deciduous molars and 24 first deciduous molars with 
extensive caries have been studied. The criteria of 
selection of teenth for treatment and study were clinical 



U.S. NAVY MEDICAL NEWS LETTER 



and radiographic evidence of deep caries; absence of 
painful pulpitis; normal response to pulp tests; lack of 
radiographic evidence of periapical pathosis; sufficient 
clinical crown to permit isolation during excavation 
and placement of the capping agent; and subsequent 
restoration with silver amalgam. Following the re- 
moval of the necrotic layer of caries, a dressing of zinc 
oxide and eugenol was placed over the residual caries 
in one-half the teeth, and in the remaining teeth 
calcium hydroxide was used as the capping material. 
All teeth were restored with silver amalgam. Pre- 
operative and postoperative periapical identical radio- 
graphs were taken utilizing the Bencow technique. Ad- 
ditional radiographs were taken at 3-, 7-, and 12-month 
intervals. Eighty-five of the teeth have remained asymp- 
tomatic through the observation period. Two teeth were 
removed because of radiographic evidence of periapical 
pathosis. Under the conditions of this study, radio- 
graphic evidence of sclerotic dentin has not been ob- 
served routinely under either of the capping materials. 
Removal of the amalgam restoration and the pulp- 
capping material at the end of the 12-month period 
has revealed caries arrestment and a sound pigmented 
dentin base. 



FLUORIDATION NEWS 
Water Newsletter 6(20): October 21, 1964. 

A report in the International Dental Journal esti- 
mates that more than 71,000,000 people throughout 
the world are drinking fluoridated water. The U.S. has 
2,519 fluoridated water supplies; Canada 202; and 
Brazil 58. Great Britain and Switzerland are said to 
have only two fluoridated community water supplies 
each. 

In the USSR, a researcher at one scientific institute 
has studied the effects of a local water supply which 
has a natural fluoride content of 4ppm (present recom- 
mended level for artificial fluoridation is Ippm) and 
says that mottling of the teeth of the town's oldsters 
is the only detrimental effect. On the credit side he 
found that death rates from cancer, TB, and heart 
disease for the years studied were lower in that town 
than in other areas with less or no fluoride in the 
water. New studies will attempt to determine whether 
fluoride is useful as a deterrent for conditions other 
than tooth decay. 



In Austin, Minnesota, dentists reported a reduction 
in dental caries in six-year-olds of 70 percent after 
fluoridation of city water. When local political pres- 
sure forced the discontinuance of fluoridation, the 
caries rate in this group doubled during the next three 
years. 

Rust in the water led to the loss of fluoridation in 
Riverhead, N. Y., despite the overwhelming support 
of local health authorities. The fluoride, added to the 
water since 1952, was blamed for rusty dirty water 
despite the fact that consulting engineers told the town 
board that the high iron content of the city water was 
the cause of the rust. 

RETENTIVE PROPERTIES OF DENTAL 
CEMENTS 

Oldham, Drew F„ Swartz, Marjorie L., and Phillips, 
Ralph W. Indiana University School of Dentistry. J D 
Res 14: 760-768, July-August 1964. D Abs 9(10): 632, 
October 1964. 

A test of the retentive property of six commercial 
dental cements showed that zinc phosphate cement 
offered the greatest resistance to removal, with a 
silicophosphate cement a close second. In descending 
order of retentive power were silicate cement and 
three brands of zinc oxide-eugenol cement. One mate- 
rial, Temp-Bond, designed and marketed only for 
temporary cementation, exhibited less retention than 
the other cements. 

A study of the effect of five cavity liners and bases 
on the retentive property of zinc phosphate cement 
showed that only one — the calcium hydroxide liner, 
Pulpdent — reduced the retention of the inlays. 

The cements and liners were tested by preparing 
cavities in extracted upper molars, cementing inlays 
with hooks into the cavities and measuring the stress 
required to remove the inlays. 

The results are in close agreement with those obtained 
in a similar investigation assessing the abilities of 
cements to retain orthodontic bands (J. D. Williams, 
1963). Based on the information obtained in the pres- 
ent study, zinc oxide-eugenol material would not be a 
wise choice to use for cementation in regions of high 
stress or where retention is greatly dependent on the 
cementing medium. Use of a cavity varnish before 
cementation, to protect the tooth from the phosphoric 
acid present in certain types of cements, can be recom- 
mended without fear of a deleterious effect on retention. 



Recent studies carried out on more than 12,000 sera and samples of cerebrospinal fluid suggest that the fluores- 
cent treponemal antibody (FTA) test is destined to become one of the basic serological diagnostic tests for 
syphillis.—WHO Chronicle 18(8): 308, August 1964. 



10 



U.S. NAVY MEDICAL NEWS LETTER 



PERSONNEL AND PROFESSIONAL NOTES 



U.S. Navy Dental Officer Presentations. CAPT W. A. 
Monroe DC USN, U.S. Naval Training Center, San 
Diego, California, and CDR C. A. DeLaurentis DC 
USN, USS ST. PAUL, operated before fellow members 
of the American Academy of Gold Foil Operators at 
the Annual Meeting held 6 November 1964, at the 
University of California Dental School in San Fran- 
cisco, California. 

They used the "musical chairs" approach to demon- 
strate the value of standardized instrumentation and 
procedures in Gold Foil Operations. Upon a given 
signal each would immediately exchange patients and 
continue the foil operation at whatever stage they 
found it. 

CAPT Norman B. Shipley DC USN, Naval Auxiliary 



Air Station, Meridian, Mississippi, presented a paper 
entitled 'Autogenous Dental Transplants" before the 
Meridian Area Dental Society on 17 November 1964, 
at the NAAS Officers Club. The meeting was hosted by 
CAPT Shipley, who later was elected to serve as Vice- 
President of the Society for the year 1965. 

CAPT Kimble A. Traeger DC USN, U. S. Naval 
Hospital, Philadelphia, Pennsylvania, presented a lec- 
ture entitled "Treatment of Maxillary Fractures" be- 
fore the Delaware Valley Society of Oral Surgeons on 
18 November 1964. 

Four dental officers from the ELEVENTH Naval 
District presented table clinics during a meeting of the 
San Diego County Dental Society on 7 December 1 964. 
The clinicians and their topics were : 



CAPT William M. Marking DC USN 

US Naval Station, San Diego, Calif. 

CAPT Tomas C. Pablos DC USN 

US MarCor Recruit Depot, San Diego, Calif. 

CDR Joseph E. Hartnett DC USN 

US Naval AmPhibBase, San Diego, Calif. 

LT David J. Kmtchkoff DC USNR 

US Naval Station, San Diego, Calif. 



Concepts of Partial Denture Design 
The Bar Fixed Partial Denture 
Temporomandibular Joint Roentgenography 
Dynesthetics 



CAPT Theodore R. Hunley DC USN, U.S. Naval 
Dental School, NNMC, Bethesda, Maryland, presented 
two projected lectures entitled "Basic Crown and 
Bridge Concepts in Short Span Bridges" before the 
Greater New York Dental Society, 8-9 December 1964, 
in New York, New York. 

Three dental officers from the U.S. Naval Dental 



School, NNMC, Bethesda, Maryland, were invited to 
participate at a meeting of the District of Columbia 
Dental Society, on 8 December 1964, in Washington, 
D.C. They presented a three-fold discussion concern- 
ing pertinent problems in everyday practice of General 
Dentistry, entitled "Advanced Procedures of Dental 
Operations." The clinicians and their topics were: 



CAPT JOHN W. Pepper DC USN 
CAPT Lloyd M. Armstrong DC USN 
CAPT Peter F. Fedi, Jr. DC USN 



Reinforcing a Single Tooth 

Splinting Three Teeth 

Assisting Crown and Bridge Procedures via 

Peridontal Surgery 



During the 131st Annual American Association for 
the Advancement of Science held in Montreal, Canada, 
26-31 December 1964, two U.S. Navy Dental Officers 
participated in a four-session symposium on "Environ- 
mental Variables in Oral Disease." As noted in the 
U.S. Navy Medical News Letter 45(1), CAPT Fred L. 
Losee DC USN, participated in Part I, Geographic and 
Clinical Considerations. 



Robert van Reen PhD, National Naval Medical 
Center, presided over Part II, The Oral Environment — 
Nutrition and Dental Caries. During this second ses- 
sion, CAPT Gordon H. Rovelstad DC USN, U.S. Naval 
Dental School, NNMC, Bethesda, Maryland, presented 
a scientific paper concerning salivary components and 
their relationship to oral disease status. 



U.S. NAVY MEDICAL NEWS LETTER 



II 



Stag DO-CMC Participates in Civil Defense Confer- 
ence. CAPT Victor J. Niiranen DC USN, participated 
in the Sixth National Dental Civil Defense Conference, 
sponsored by the Council on Federal Dental Services, 
at the recent Annual Meeting of the American Dental 
Association in San Francisco, California. 

CAPT Niiranen presented a lecture, "The Role of 
the Dental Profession in Disaster: Theory and Practice" 
in which he stressed the role of the dentist during times 
of disaster. He stated assistance by the dentist may 
be provided in any one of three ways: 

{ 1 ) Direct emergency care may be given by the ad- 
ministration of anesthetics, parenteral therapy or the 
treatment of wounds, burns, shock, or radiation. 

(2) Administrative assistance could be provided by 
organizing groups for a concerted effort or by arrang- 
ing for the provision of needed facilities and supplies. 

(3) Train others in the treatment of casualties. 



Identification of Qualified Oral Surgery and Ticonium 
Technicians. Responsible dental officers are requested 
to notify BuMed (Code 6133) when dental technicians 
become qualified as Oral Surgery Technicians or as 
Ticonium Technicians. The standard for qualification 
as Oral Surgery Technician shall be the applicable 
portions of the Hospital Corps' Operating Room Tech- 
nic Course or its equivalent. The standard for qualifica- 
tion as Ticonium Technician shall be the Ticonium 
Technics Course of the CMP Industries, Albany, New 
York., or its equivalent. 

A notation of such qualification will be made in each 
man's record for use as an aid in making future as- 
signments. 



Dental Officers Retire. The following dental officers 
retired during the second quarter of Fiscal Year 1965: 

CAPT Roger G. Gerry DC USN 

CAPT John C. Robie DC USN 

CAPT James G. Rogers DC USN 

CAPT Christopher E. Thomlinson DC USN 



CAPT John V. Reilly DC USN 
CAPT Jerome F. Peters DC USN 
CDR Donald J. Miller DC USN 
CDR Henry J. Ruff DC USN 



Lack of Accident Insurance Cost Serviceman $50,000. 
A recent court judgment against a young military man 
involved in a serious automobile accident vividly brings 
forth the importance of purchasing enough liability in- 
surance on your car. 

"Enough" will vary with the individual and should be 
determined only after consulting your insurance agent. 

The young man, an E-3, was convicted of negligent 
driving resulting in the death of a passenger in the other 
car involved. A judgment of $50,000 was placed 
against him. He had no insurance on his car. 

By his lack of consideration concerning the impor- 
tance of proper insurance, this young man placed him- 
self practically in voluntary brankruptcy for the better 
part of his life. Until he pays the $50,000 in full, he 
can never own or purchase anything other than the 
necessities of life. His credit standing can be con- 
sidered worthless. No matter where he goes, this 
stigma follows. If he leaves the service the opportunity 
of ever obtaining a worthwhile position has been seri- 
ously jeopardized. All this burden to carry simply 
because he lacked a little forethought. 

The significance of this indifferent thinking should 
require no further emphasis. The cost of proper and 
sufficient insurance on your car, no matter how high it 
may seem, is but a fraction of what it will be in dollars, 
morale and your future position in life if a judgment is 
placed against you. 

Assure your peace of mind by insuring yourself 
against an unhappy future. 

This story, appearing in the NAS Miramar JET 
JOURNAL XIV (31): 3, Nov 25 1964, should be 
brought to the attention of all personnel. — BUMED 
Code 611. 



SEMINAR ON CULEX PIPIENS COMPLEX 

A WHO seminar on the ecology, biology and control 
of the Culex pipiens complex was held in Geneva from 
31 August to 2 September 1964. The seminar, at which 
about 20 countries were represented, has particular 
importance in view of growing urbanization, which has 
resulted in an increase in Culex pipiens fatigans breed- 



ing and the transmission of filariasis. 

Extensive data on the Culex pipiens complex and its 
control have been collected during the past three years 
in different parts of the world. These were studied at 
the seminar along with material from the WHO Filiar- 
asis Research Unit in Rangoon, Burma, which has now 
been in operation for some 18 months. — WHO Chron- 
icle 18(8): 311, August 1964. 



12 



U.S. NAVY MEDICAL NEWS LETTER 




PREVENTIVE MEDICINE 



VECTOR ECOLOGY AND INTEGRATED CONTROL PROCEDURES 



Laird, Marshall, Supple to Bull Wld Hlth Org 29: 147-151, 1963, 



RELATIONSHIPS BETWEEN VECTORS 
AND ENVIRONMENT 

Such terms as "bionomics" and "ecology" are often 
used rather loosely in mosquito survey reports and 
other general papers on medical entomology. Thus the 
first commonly boils down to little more than a mere 
cataloguing of "mosquito breeding-places," and the 
second to a few remarks on certain associated plants 
and animals (seldom specifically identified) that hap- 
pened to attract the investigator's attention. This is 
symptomatic of the attitude that permited "mosquito 
breeding-place" to become firmly entrenched in the 
literature in the first place. It is submitted that while 
we persist in so designating the various types of mos- 
quito-producing water collections, attempts to classify 
the latter systematically are likely to end in failure. 

Well do they deserve to do so, when resting on the 
implication that the major ecological attribute of such 
waters is their utilization by particular mosquitoes. This 
suggests a simplicity that is unfortunately illusory, as 
even quite small natural water bodies may support 
startlingly complex communities of diverse plants and 
animals. By way of illustration, while it does not seem 
out of the ordinary that a Singapore duck pond the size 
of a tennis court and rich in organic pollutants should 
harbour more than a hundred species of organisms 
referable to most of the major groups of fresh water 
life, it may occasion surprise that as many as 202 



species of animals and plants have been identified from 
a subarctic Canadian snow-melt pool only 2.5 metres 
in diameter (unpublished data). Moreover, in neither 
of these cases was the picture ever quite the same at 
successive samplings, both associations having dynamic 
status and differing from one day to the next. 

Each of these water bodies supported developmental 
stages of several species of mosquitoes. Some of the 
latter harboured endoparasites and their body surfaces 
always bore epibionts, notably filamentous sewage 
bacteria and certain ciliate protozoa. There have been 
instances where specialists in the Culicidae, intent 
upon collecting mosquitoes alone from a "breeding- 
place," have encountered such epibionts and automat- 
ically assumed them to be specific parasites. Indeed, 
the literature is rich in names proposed for freshwater 
epibionts on the completely unjustified assumption of 
strict host-specificity. A wide range of taxonomists in 
other fields, be it noted, shares with medical entomolo- 
gists this weakness for viewing water bodies primarily 
as the source of their own particular subject material. 

Ciliate epibionts include representatives of the genus 
Vorticella, many species of which now have been de- 
scribed from freshwater organisms, from algae, rotifers 
and microcrustaceans to higher forms of many kinds 
including immature mayflies, chironomid midges and 
mosquitoes. Regrettably often, the authors concerned 
have neither admitted the possibility that their vor- 
ticellid might already be known from hosts other 



U.S. NAVY MEDICAL NEWS LETTER 



13 



than the one before them, nor have they followed the 
International Code of Zoological Nomenclature by de- 
positing type material in reference collections. Syno- 
nyms have multiplied, and indeed it seems likely that 
numerous presumed species of Vorticella are really 
referable to the cosmopolitan and pollution-tolerant 
V, microstoma. At all events, this proved to be the 
dominant species on the larvae in the Singapore pond 
already mentioned, and not only on them, but on many 
of the associated organisms as well. It was the degree 
of pollution that determined the composition of the 
epibiotic communities, which proved to succeed one 
another in a predictable sequence as pollution levels 
fluctuated (Laird, 1959). Under laboratory as well as 
field conditions such epibionts can help to kill mosquito 
larvae and other aquatic life already at a disadvantage 
through exposure to an adverse environment character- 
ized by pollution levels near their limits of tolerance 
{Laird, 1958). 

At Singapore, the level of pollution in the pond men- 
tioned reflected how recently its Chinese owner had 
enriched the water with manure for the benefit of a 
water-hyacinth crop. In subarctic Canada, where a 
different epibiotic ciliate was implicated but the same 
principle held good, springtime sources of organic pollu- 
tion included the decomposing remains of frozen 
plants and animals and the faeces of migratory birds. 

It would therefore seem evident that the bionomics of 
developing mosquitoes, like other sectors of freshwater 
ecology, can only be fully understood against detailed 
background knowledge of the ecosystem. In context, it 
would surely be in the interest of clarity to abandon the 
term "breeding-place" in favor of the increasingly 
widely used "larval habitat." 

The web of interrelationships between a given mos- 
quito and its organic and inorganic environment can- 
not be unwoven without exact knowledge of food 
chains, of the relative importance of the various preda- 
tors dwelling in the habitat, and of many other such 
matters. Existing information on these subjects, 
although voluminous, is often less helpful than might 
have been anticipated. For example, a good deal of 
the earlier writings on mosquito larval nutrition com- 
prised analyses of the gut contents of larvae. Some 
of the most resistant and easily identifiable elements 
located during such dissections (e.g., certain diatoms 
and desmids) often pass out from the body without 
having been of any food significance at all. On the 
other hand, delicate flagellates and ciliate (comprising 
a large part of the biomass and an important source of 
larval nutrition) cease to be recognizable moments 
after ingestion. Therefore, they are not noted in the 
midgut contents. Again, a predacious dytiscid beetle 
that, in the absence of other prey, devours mosquito lar- 
vae from its natural habitat when imprisoned with 
them in a small laboratory container does not neces- 



sarily exercise a preference for mosquito larvae from 
among the range of alternatives normally confronting 
it. 

There has long been theoretical appreciation of the 
roles of pathogens, parasites, predators and other en- 
vironmental factors in the natural limitation of pest 
populations, but only recently has the importance of 
this factor been seriously considered in meeting control 
problems. By the time the latter are faced, urgency 
is usually their keynote and measures yielding im- 
mediate and obvious results are being demanded. Where 
this leads to the wholesale use of non-selective pesticides 
without preliminary ecological investigations, there is 
not only no baseline for the critical evaluation of the 
results, but new problems may be caused and old ones 
aggravated through the disruption of biotic equilibria. 
An early example of the latter, ultimately benefiting 
the organism under attack, concerns an attempt to 
control blackflies in an Ontario stream in 1944 (Davies, 
1950). DDT was applied at what would now be re- 
garded as a highly excessive dosage, bringing about 
spectacular but short-lived control of simuliids. A 
year later, due to the fact that the obliterated com- 
munities of relatively long-lived benthic predators had 
not yet re-established themselves, the average black- 
fly emergence rate for a test zone of the stream was 
about 17 times that of the precontrol period. As larv- 
iciding is being regarded as a major part of vector 
control measures associated with the reduction of 
onchocerciasis, it should be pointed out that recent 
field studies in East Africa (Hynes & Williams, 1962) 
have again stressed the danger of freeing blackfly pop- 
ulations from predator pressure. Hynes & Williams' 
studies even suggested that unwitting predator eradica- 
tion through the misuse of insecticides would be a 
distinct possibility. Possible long-term consequences 
of such an eventuality being self-evident, there is a 
strong case for more liaison between vector control 
and limnology. 

Some recent examples are pertinent at this juncture. 
One of these concerns the Australian part of New 
Guinea, where the partial extraction of Anopheles 
farauti from the environment by means of residual wall 
sprays alone was followed by the unexpected exploita- 
tion by pest culicines of the under-utilized larval 
habitats formerly occupied by the anopheline (I. M. 
Mackerras — personal communication, 1961). The re- 
sult was a very significant increase in the numbers of 
biting attacks by "wild" culicines, a fact that did not go 
unnoticed by the local Melanesian population whose 
confidence in the mosquito-reduction powers of their 
medical authorities was lowered accordingly. This 
evidence of the replacement of one insect species by 
another could conceivably have some practical appli- 
cation (e.g., replacement of a vector by an insect with- 
out public health interest — of an anopheline by a 
dixid midge, for example). 



14 



U.S. NAVY MEDICAL NEWS LETTER 



The second example concerns Sarawak, on the is- 
land of Borneo, where thatch-destroying caterpillars of 
Herculia moths have increased in number as a direct 
result of an active malaria eradication program. In 
this instance, household insecticidal residues have 
killed not only anophelines but also a hymenopterous 
parasite of the thatch moth concerned. The latter, 
safe within the roofing material, has flourished accord- 
ingly (Cheng. 1963). 

Lastly, it is widely known that increases in bedbug 
populations have accompanied malaria eradication wall 
spraying in certain areas. Bedbug resistance to insecti- 
cides is a factor here, but it is not necessarily the 
only one. Studies in Delhi (Wattal & Kalva, 1960) 
showed that a contributory factor was the removal of 
predator pressure by wall spraying; caterpillars of a 
common Indian household pest, the Py rails pictalis 
moth, proved to have been destroying significant num- 
bers of bedbug eggs prior to the inception of the spray 
program. It has repeatedly been said that populations 
which have been freed from malaria and other vector- 
borne diseases henceforward expect higher standards 
of pest control generally. Problems such as those re- 
ferred to are going to have to be solved from this 
standpoint, if not from that of disease transmission. 

INTEGRATED CONTROL PROCEDURES 

Painstaking investigations of the ecological effects of 
chemical control projects on arthropod populations in 
orchards (Pickett, 1961) have recently indicated that 
biotic control agents usually constitute the major por- 
tion of the environmental resistance to increases in pest 
numbers. In the field of economic entomology gen- 
erally, there is a growing realization that this is so 
and that insecticides should be fitted into the eco- 
system instead of being imposed upon it. Those re- 
sponsible for control projects involving insects of 
agricultural and forestry importance are thus actively 
developing integrated control procedures. There is in 
fact a great deal to be learned from the experience 
gained in the economic field, and, just as has been 
remarked concerning limnology, there is much to be 
gained from closer liaison between public health en- 
tomologists and economic entomologists. 

Integrated control procedures supplement chemical, 
physical or cultural control measures with effects of 
the natural enemies of undesirable organisms. Inte- 
grated control should not be confused with dual- or 
multi-purpose control — that is, the simultaneous attack- 
ing of two or more pests by means of a single proce- 
dure. Neither should it be mixed up with co-ordinated 
control, which involves co-operation between two or 
more agencies with the object of minimizing clashes 
of interests while both are working upon a particular 
ecosystem. 



Integrated control procedures involve, firstly, avoid- 
ing loss of the effectiveness of established complexes 
of natural enemies of undesirable insects through ap- 
propriate timing, sitting and formulation of insecticidal 
applications. 

As regards timing, this is a matter on which advice 
must be sought from the ecologist, who is in the best 
position to designate the point at which a vector popu- 
lation can be attacked with maximal effect. A case in 
point would be the widespread application of larvicides 
to subarctic snow-melt pools early in spring — early 
enough to reduce heavily the initial pest Aedes which 
rapidly develop almost free from predator attack, al- 
though not so late as to harm the complex associations 
of arthropod predators which subsequently develop and 
thereafter serve as valuable limiting factors upon 
mosquito populations. Appropriate formulation would 
be important in this connexion too. Recent Californian 
investigations (those of Mulla et al, 1962, for instance) 
have suggested that by carefully regulating dosage rates 
and formulations, and through the selective activity of 
certain organophosphorus and carbamate compounds, 
mosquito control may be implemented in surface waters 
without unduly affecting natural enemies. Fish and 
even arthropod predators may be conserved through 
this approach. Again, it has been suggested that in- 
soluble suspended insecticidal particles might be em- 
ployed to combine a high blackfiy kill with minimum 
destruction of associated organisms. 

Secondly, integrated control procedures may combine 
other control measures with biological ones, that is to 
say, with direct or indirect manipulation of natural 
enemies (pathogens, parasites and predators), to in- 
crease the incidence of mortality in the population 
under attack. In this context, biological control also 
embraces autocidal control, involving sterilization and 
genetical procedures by which individuals of a pest 
species are manipulated to harm their own kind. Among 
the "other" control measures sanitary ones should be 
specially mentioned for these have too often been ne- 
glected in the era of synthetic insecticides. 

Indirect manipulation of natural enemies for inte- 
grated control was actually achieved on a local scale in 
Malaya before the Second World War. I refer to the 
deliberate pollution of ponds to render them unattrac- 
tive to vector anophelines. One of the immediate con- 
sequences of such pollution was the flourishing of 
vorticellid and other epibionts. As already mentioned, 
these seem especially harmful to mosquito larvae weak- 
ened by a trend towards anaerobic conditions in their 
surroundings. 

A very pertinent example of direct manipulation 
from the agricultural field is provided by recent studies 
in the USSR involving the joint use of fungal pathogens 
and insecticides to provide synergistic effects, the com- 
bined effect of the chemical and biological methods 



U.S. NAVY MEDICAL NEWS LETTER 



15 



proving better than the sum of their individual applica- 
tions. Again, during recent WHO-sponsored field 
experiments in the Tokelau Islands, the fungus Co- 
elomomyces stegomyiae was found to be a promising 
candidate biological control agent against the local 
vector of bancroftian filariasis, Aedes polynesiensis. At 
the same time, dieldrin-cement briquettes proved very 
useful for the long-term prevention of mosquito breed- 
ing in household water drums in the villages. There 
would seem to be a good case here for devising an 
operational control procedure based upon the joint 
employment of Coelomomyces and other self-perpetuat- 
ing biological control agents in bush areas of such atolls, 
and insecticidal briquettes in the peridomestic zone. 
An operational integrated control procedure on these 
lines might well achieve the interruption of filariasis 
transmission. 

It is submitted that integrated vector control pro- 
cedures based upon sound ecological preparations offer 
a way out of the resistance impasse — a way, more- 
over, that guarantees a much more selective form of 
control and offers prospects of economically reducing 
vector populations to levels at which human disease 
transmission ceases. Furthermore, the long-term 
nature of the reduction achieved would help prevent the 
resurgence of pest populations following the completion 
of vector control programs. Of course, a great deal 
more research must be done before there is any pros- 
pect of practicable vector control along these lines. 
A first essential in developing such a research program 
should be the devising of appropriate collecting and 
measuring techniques followed by the co-ordinated col- 
lection of necessary basic data (on vector ecology 
as well as on related aspects of biological control) on 
a global scale. 

Summary. The elucidation of population regulatory 
mechanisms calls for exhaustive biological and eco- 
logical studies of whole ecosystems. Until lately, 
little effort was made to relate insect control activities 
to such a background, and the use of non-selective 
pesticides has often resulted in biotic equilibria being 
disrupted to the ultimate advantage of the organism 
under attack or of some other undesirable species. 
However, there is a growing realization in the field of 
economic entomology at large that biotic control agents 
usually constitute the major portion of the environ- 
mental resistance to increases in pest numbers and 
that insecticides should be fitted into the ecosystem, 
and not imposed upon it — in fact, that integrated con- 
trol procedures are called for. 

The author considers such integrated procedures 
from the standpoint of vector control. His paper 
points out their potentialities in helping to solve resist- 
ance problems and in increasing the selectivity of con- 
trol operations. It further suggests that they offer the 
means of achieving economical and lasting reductions 



of vector populations to levels at which human disease 
transmission is interrupted and pest problems lose 
much of their importance. 

A LOCALIZED OUTBREAK OF 
COCCIDIOIDOMYCOSIS IN MEXICO 

Meehan, Herbert MD, Los Angeles County Health 
Index, 41st Report Week, Ending 10 Oct 1964. 

About the middle of July 1964, 13 individuals, from 
widely varied places in the United States, set up a camp 
approximately 5 miles south of Tijuana, Mexico, near 
the orphanage, Casa de la Esperanza, on the road to 
Ensenada, in order to excavate a site to enlarge the 
orphanage. This was a project of the Service Com- 
mission of the Brethren Church, and those involved 
were all volunteers. One week later, 2 additional per- 
sons joined the group and the following week another 
arrived, making a total of 16. Their work consisted of 
moving dirt with picks and shovels for the foundation 
of the addition to the orphanage. The area was hot and 
dry, and it was a dusty operation. 

They brought food with them and prepared their 
own meals. Water was obtained from an approved 
source. Only powdered milk was used. Sewage disposal 
was by means of open privies. Flies were numerous. 

Approximately 2 weeks after operations began, ill- 
ness began to occur among this group. At the end of 
4 weeks, 8 of the 16 (50%) in camp, had been listed 
as victims of this illness. At this time it was decided 
to abandon camp and return to the United States. 

The symptoms varied from lassitude, malaise, and 
weakness in the milder cases, to chills, sweats, fever, 
headache, cough, chest and back pains, joint pains and 
rash, especially on the legs, in the more severe cases. 

The 8 who did not become ill included the cook and 
her 3 children who did no excavating, 2 women who 
only did clerical work, one boy who arrived a week 
late and did mostly construction work and the one who 
arrived 2 weeks late and only worked in the deeper part 
of the excavation. All who worked at removing the 
upper layers of dirt became ill. 

The patients were seen by physicians in various parts 
of the United States upon their return to their respective 
homes. In only one of these cases was there a diagnosis 
of coccidioidomycosis. In that case the diagnosis fol- 
lowed a third admission to a hospital, in Pittsburgh, 
Pennsylvania. 

The diagnosis of the individual case of coccidioido- 
mycosis presents difficulties as the disease is most fre- 
quently subclinical or the illness transient. When the 
illness can be related to other similar illness in a 
group with a common exposure such as the 16 persons 
working at the orphanage in Mexico, the possibility of 
coccidioidomycosis is suggested. 



16 



U.S. NAVY MEDICAL NEWS LETTER 



Coccidioidomycosis is a fungus infection resulting 
from a fungus found in the soil in many parts of south- 
western United States, and Mexico. 

The incubation period varies from 10 days to 3 weeks 
and the illness may occur at any age. Its most severe 
form occurs most commonly among the colored races. 
There are two major types — the primary infection and 
progressive coccidioidomycosis. Only 0.2% of primary 
cases develop the progressive fatal infection. If the 
primary infection persists for 5 to 6 weeks with signs, 
symptoms and x-ray findings, the widespread, general- 
ized infection of the progressive type should be sus- 
pected. Complement-fixing antibodies in high titer 
indicate spreading infection and a poor prognosis. This 
protean disease may mimic tuberculosis, syphillis, and 
other mycotic infections, such as actimomycosis, 
sporotrichosis and blastomycosis. 

Miscroscopic analysis of pus, sputum, and of the 
sediment of centrifuged pleural fluid and gastric con- 
tents may all assist in the diagnosis. Infected materials 
may be cultured on various media. Mice should be 
inoculated intraperitoneally with either infected mate- 
rial or suspicious cultures. When positive, the char- 
acteristic spherules can be found in the tissues or 
exudates of such animals. 



TURTLES AS A SOURCE OF 
SALMONELLOSIS 

Reported by Epidemiologist, Div Communic Dis 

and Asst Vet Off, Mass Dept Hlth, CDC, Salmonella 

Surveillance, Rpt No. 30 p 7, 28 Oct 1964. 

Increasing number of reports of turtles as potential 
reservoirs of salmonella organisms, prompted the Di- 
vision of Communicable Diseases investigated cases of 
salmonellosis involving relatively uncommon sero-types 
which have been associated with turtles in other parts 
of the country. Salmonella braenderup was chosen, and 
2 isolated cases in children were investigated. Upon 
questioning it was found that both had contact with 
pet turtles within their home. 

One case involved an 8 month-old girl who became 
ill on August 1, 1964, with bloody diarrhea and fever. 
Symptoms persisted for approximately one week. At 
the time the family was caring for a neighbor's pet 
turtle. The infant apparently had no direct contact 
with the turtle, but the mother, in caring for the turtle, 
changed the turtle water in the kitchen sink. No other 
family member reported any symptoms of illness. On 
Sept. 1, the turtle in question and the turtle water were 
cultured. Both were positive for S. braenderup. 

The second case involved a family of 6 persons. On 
Mar. 27, a 6 month infant had severe diarrhea for 3 
days. The stool specimen was positive for S. braend- 
erup. No other family members reported illness but 



cultures taken from a sister 3 years of age, and the 
mother, 3 1 years of age, were positive for S. braenderup. 
This turtle's bowl was also cleaned in the kitchen sink. 
On Sept. 9, the turtle was secured and found to be 
positive for S. braenderup. No further illnesses had 
been present since March within the family. 

Following these two fruitful investigations, it was 
decided to randomly sample a number of chain stores 
supplying pet turtles to the community. Two turtles 
were secured from each of the 5 stores. Eight of these 
were positive for salmonella. Serotyping has not been 
completed. The two negative turtles were secured from 
the same store, where 140 mg. of Aureomycin (R) 
per 9 gallons of water were added to the aquarium to 
prevent the growth of "fungi". The effect of this level 
of Aureomycin on salmonella growth will be investi- 
gated. No isolates were made from samples of turtle 
feed used in these establishments. 

Editor's Comment: A most valuable investigation. 
Worthy of note is the fact that the turtles positive for 
S. braenderup had in all likelihood been carrying the 
organism for some time. As is frequently the case, 
the feed was negative for salmonellae. In all likelihood 
the turtles are infected either at the store prior to dis- 
tribution, or more likely at the turtle farm where 
rendered meat scraps and chicken offal are frequently 
used as food. 



VACCINE FORECAST FOR CHAGAS 
DISEASE 

This Week in Public Health, Mass Dept of Pub Hlth, 
13(39): 388, 23 Sept 1964. 

Vaccination against insect-transmitted Chagas' Dis- 
ease, long thought impossible, is now conceivable, ac- 
cording to a report made to the American Society of 
Parasitology by a representative of Ciba Pharmaceutical 
Co. This company has developed a vaccine that im- 
munized mice for four months against experimentally 
produced infection. This gives a ray of hope to more 
than 7 million persons in South and Central America 
who are afflicted with the often fatal sickness. 

Chagas' Disease, which usually begins in the first 
10 years of life, starts, in 25 — 75% of cases, by affect- 
ing the eye. While pain is mostly mild, the skin around 
the eyes reddens and swells. Two main stages follow. 
In the acute period fever strikes, eruptions of various 
types appear on the skin, and lymph nodes are en- 
larged. At the later chronic level, serious heart prob- 
lems become evident. 

The new experimental vaccine, which kept its potency 
for at least three months when deep-frozen, is made 
by "physically" killing Trypanosoma cruzi, the causal 

parasite. 



U.S. NAVY MEDICAL NEWS LETTER 



17 



EAR-INVADING BEETLES ACTIVE 
AGAIN AT BOY SCOUT JAMBOREE- 
VALLEY FORGE, PA. 

Reported by Eldon P. Savage, State Aids Section, 

CDC, Atlanta, Ga., Vector Control Briefs, Issue 

No. 13, Sept 1964. 

Human ear invasions by the Asiatic garden beetle, 
Austoserica castanea, were a serious problem at the 
6th National Boy Scout Jamboree, Valley Forge 
National Park, Pennsylvania. From 13-23 July 1964, 
a total of 39 ear invasions among 52,000 scouts and 
leaders occurred in comparison with 1 86 cases at the 
1957 Jamboree at Valley Forge. 

This beetle was first recognized in America, in New 
Jersey, in 1922, and is now located at widely scattered 
points along the Atlantic seaboard. The adult beetle 
is shaped like a May beetle, is about ¥a inch in length 
and it has long tibia spines which are particularly 
troublesome after the beetle invades the ear. 

Since the larvae and pupae of the beetle inhabit the 
soil, 2 weeks prior to the Jamboree soil samples were 
taken, but only 3 larvae were found. Light trap collec- 
tions produced less than 25 adult beetles per collection. 
It appeared that the beetle problem would be minor at 
the Jamboree and that insecticidal measures were not 
warranted. 



An inspection on July 13 revealed a marked increase 
in the beetle population. Control measures, consisting 
of application of DDT granules to ground cover by a 
mist blower, were then instituted. Of the 30 sections 
of the 9,000-acre area, 13 were treated in entirety; 13 
were treated around the perimeter; and 4 were not 
treated. 

Prophylactic measures for individuals included plac- 
ing cotton balls in the ears. A major pharmaceutical 
company supplied over 300,000 cotton balls for this 
purpose. Sanitarians developed some ingenious posters 
to educate the scouts in the use of cotton. 

In spite of these efforts, ear invasions occurred 
because (1) communication broke down; (2) some 
troops ran out of cotton; (3) a few troop leaders dis- 
missed the need for its use; and (4) in several instances 
the boys lost the cotton from their ears during the night. 

Most of the ear invasions occurred while the scouts 
were sleeping on the ground; 1 case occurred in a leader 
who slept on a cot, and 1 invasion occurred during 
daylight hours while a leader was shaving. 

Although an 80% reduction in ear invasions occurred 
in 1964 as compared to 1957, better surveillance and 
application of improved control measures during non- 
Jamboree years are needed. More information is needed 
on its control as related to public health in mass 
encampments. 



KNOW YOUR WORLD 



DID YOU KNOW: 

That the 1965 Congressional appropriation to the Pub- 
lic Health Service VD Control Program is $10,030,000? 

This is a net increase of $432,000 over the 1964 
appropriation and $300,000 greater than the amount the 
Administration requested for 1965. (1 ) 



That two changes took place in rank order of the 10 
leading causes of death between 1963 and 1962? 

As a result of the influenza epidemic, influenza and 
pneumonia rose to 5th place in J 963, replacing certain 
diseases of early infancy (5th in 1962). Other broncho- 
pulmonic diseases (525-527) rose from the 13th leading 
cause in 1962 to 10th in 1963. Emphysema without 
mention of bronchitis (527.1), a subcategory of other 
bronchopulmonic diseases, accounts for most of the 
deaths in this group. (2) 



That more people died of cholera in 1963 than in any 
of the 5 preceding years? 

The World Health Organization reported that of 
65,157 cases, 21,735 were fatal as compared with 



41,575 cases and 12,016 deaths in 1962. India and 
Pakistan were the principal sufferers. (3) 



That 1 death due to plague was reported on 25 Nov. 
1964 in the District of Vryburg (Cape Province)? 

The necessary measures were taken. No case of 
plague had been reported in South Africa since January 
1962 (4 cases in Saint Marks District, Cape Province). 
(4) 



That 906 cases occurred of a febrile and eruptive 
syndrome, frequently pustular, in the city of Iquitos, 
Peru, from April 1963 through April 1964? 

Originally, this was thought to be chickenpox, but 
finally was interpreted as smallpox. Overall case fatality 
ratio was 7% . (5) 



That an epidemic of dengue-like illness occurred in 
Martinique, in late 1963 and 1st quarter of 1964 al- 
though exact number of cases is unknown due to many 
mild atypical forms being present? 

The clinical syndrome was characterized by sudden 



18 



U.S. NAVY MEDICAL NEWS LETTER 



onset, fever lasting 4-5 days (sometimes interrupted by 
a slight remission on the 3rd day), suborbital or retro- 
ocular headache, joint and muscle pains, anorexia, and 
slight eruption were present. The Pasteur Institute iso- 
lated an arborvirus Group B; it was not possible to 
identify it further as a dengue virus. Because of the 
presence of Aedes aegypti infestation in the region of 
Port-de-France, and occurrence of outbreaks of dengue 
in other areas of the Caribbean during the same period, 
the outbreak in Martinique may reasonably be attrib- 
uted to dengue. (6) 



That the health administration of Argentina reported 
7 imported cases and 1 secondary case of smallpox in 
Paso de los Libres, Corrientes Province? 

The imported cases came from Uruquaiana, Rio 
Grande do Sul State, Brazil. The secondary case is a 
20-month old child. (7) 



That 512 reported dysentry cases with 30 deaths 
occurred in Monte Carmelo, Trujillo State, Venezuela, 
from 3 May to 17 October 1964? 

In an outbreak in Tinaquillo, Cojedes State, 595 cases 
with 26 deaths of dysentry have been reported since 
29 June. Since April 1964, 4,443 cases of gastroen- 
teritis with 70 deaths and 2,905 cases of dysentry with 
63 deaths have been reported in San Cristobal, Tachira 
State, Brazil. (8) 



References : 

1. American Social Health Assn, Vol 39(7): 1, Oct 
1964. 

2. US DHEW Mo. Vital Statistics Rpt, PHS Supple- 
ment. Vol 13(8): 1-8, Nov 2 1964. 

3. Washington Post, 6 Oct 1964, Geneva, Switzerland, 
"Cholera Death Rise". 

4. WHO Wkly Epid Record, Vol 39(49) : 625, Dec 4 
1964. 

5. PASSU Reg Office of WHO, Vol XXXVI(39): 
223, Sept 23 1964. 

6. PASBU Reg Office of WHO, Vol XXXVI(41): 
236, Oct 7 1964. 

7. PASBU Reg Office of WHO, Vol XXXVI(48): 

275, Nov 25 1964. 

8. PASBU Reg Office of WHO, Vol XXXVI(48): 

276, Nov 25 1964. 



SUMMARY, INFLUENZA AS OF 
2 NOVEMBER 1964 



CDC, Influenza Surveillance, Report No. 80, page I, 
2 Nov 1964. 



Scattered clusters of febrile respiratory illness oc- 
curred in parts of Oregon that have involved individu- 
als, some of whom showed serological evidence of A 2 
influenza infection. 

A 2 virus has recently been isolated from a case of 
characteristic clinical influenza representing part of a 
relatively widespread but low level outbreak in Puerto 
Rico. Serological evidence of infection has been demon- 
strated among a number of such cases from various 
parts of the Island. The virus isolate now being char- 
acterized in detail is readily identified using antisera 
against A 2 /Japan/ 170/ 1962 widely employed in virus 
serological laboratories. 

Preliminary communications from Hawaii describe 
an outbreak of respiratory illness on Oahu Island 
during the past month which appears serologically 
to be caused by influenza virus Type B, seemingly more 
related to the 1959 Maryland strain than to a 1962 
Taiwan isolate. 

The occurrence of these unseasonal outbreaks of in- 
fluenza is presently not expected to alter the limited 
prospects for major outbreaks on the continent this 
winter. Careful surveillance in the coming weeks will 
be of importance to document the anticipated pattern. 

International: Isolated outbreaks of influenza attribut- 
able to A„ strains have occurred sporadically in vari- 
ous parts of the world since midspring. No epidemio- 
logical or clinical variations have emerged from these 
epidemics to suggest altered virus capacity. Virus 
strains have varied somewhat, but available evidence 
does not support a major antigenic shift. 



TWO NEW SCHOOLS OF ADVANCED NURSING 
IN EUROPE 

The WHO Regional Office for Europe is assisting in 
the establishment of two International Schools of Ad- 
vanced Nursing Education, one in Edinburgh and the 
other in Lyons. 



The purpose of both these schools is to prepare 
nurses for positions of leadership in selected specialized 
branches of nursing, for the administration of nursing 
education programmes and nursing services, and for 
research in nursing, and to expand facilities for ad- 
vanced nursing education in Europe. 



U.S. NAVY MEDICAL NEWS LETTER 



19 



SNAKE STORY 

Recently, a 20 year old Marine private stationed in a 
tropical area of this hemisphere was standing routine 
guard duty, and in the early morning hours he heard a 
faint restling in the nearby undergrowth. Investigating, 
he discovered the source of the noise, a snake. He 
pinned the snake just behind the head with a stick, and 
then reached down to grab it. The result was a bite on 
the right index finger by a Fer de Lance, one of the 
highly poisonous pit vipers. Fortunately, antivenin 
serum was available and adequate treatment was ad- 
ministered in less than one hour following the bite. The 
soldier had to endure only a few days suffering and 
only lost 17 days from duty. It could have been 
worse. With delay in treatment or absence of ade- 
quate antivenin therapy the mortality from poisonous 
snake bites rises rapidly. 

Navy and Marine Corps personnel are frequently 
assigned to areas where poisonous snakes are hyper- 
endemic. The natural American tendency is to try to 
catch them. And indeed, captured specimens are use- 
ful in identifying the prevalent species and for determin- 
ing overall poisonous snake population. For these pur- 
poses, a dead snake is as good as a live one. So for 
safety's sake, kill it first. 

— PrevMedDiv, BUMED 



NATIONAL ASSOCIATION OF SANITARIANS 

The National Association of Sanitarians was founded 
and incorporated in 1937. At the present time there 
are 38 state sections, 14 standing committees, and 25 
project committees, with a membership of approxi- 
mately 5,000. The basic purpose of this group is to 
assist in providing a fit environment in which people 
may live and to aid its membership in equipping them- 
selves professionally to perform effectively in the ac- 
complishment of this purpose. Its broad objectives 
include the following: 

To provide specific services in the field of environ- 
mental health for individuals and official and voluntary 
agencies; to assume the obligations of the sciences and 
arts for the advancement of public health; to uphold 
and increase the standards of the environmental health 
profession; to search continually for truths and dis- 
seminate these findings to colleagues and interested 
parties; to strive for knowledge and be fully informed 
of the developments in the field of public health; to 
fully cooperate with all allied public health agencies; to 
promote the highest attainable standards of health to 
every human being without distinction of race, religion, 
cultural background, economic or social condition. 



The National Association of Sanitarians also works 
closely with the military services. Probably its biggest 
function is to help in the area of employment following 
discharge from the Service. 

Until 1 January 1966, any person who is a qualified 
sanitarian and employed by a governmental agency in 
public health work, or in public health education or 
inspection service by a private employer, or a student 
working for a degree in environmental health in the 
United States or other nations, is eligible for member- 
ship. This includes the three branches of military 
service. Following that time, requirements for member- 
ship will be: 

One year of experience in the field of environmental 
sanitation and a bachelors degree with a minimum of 
thirty semester units of academic work in the sanitary, 
physical, and biological sciences in addition to satis- 
factory completion of an examination. 

Cost for membership with the N.A.S. is $10.00 per 
year. Membership application blanks can be obtained 
by writing: 

National Association of Sanitarians 
Room 208, Lincoln Building 
1550 Lincoln Street 
Denver, Colorado 80203 

A resume of education and experience, accompanied 
by a check for $10.00, will be acceptable in lieu of a 
completed application blank. This $10.00 membership 
fee includes a subscription to the internationally recog- 
nized Journal of Environmental Health, a bi-monthly 
publication which will help in keeping abreast of de- 
velopments in the field of environmental health. 

The immediate program of the organization is as 
follows: 

1 . Promote the professionalization of sanitarians 
through the establishment of suitable academic stand- 
ards. 

2. Foster post-graduate education in the field of 
environmental health. 

3. Assist in the development of programs for the 
provision of a fit environment for the citizens of Amer- 
ica and other nations. 

4. Aid in the control of those environmental factors 
that may have a direct influence on the transmission 
of diseases and the health and well-being of individuals 
and society. 

5. Development of effective liaison with official and 
voluntary organizations, civic leaders, governmental 
units, professional societies, educational organizations, 
and industries that have responsibilities or concern in 
the advancement of environmental health in order that 
coordinated community sanitation programs and ac- 
tivities may be provided the public. 

6. Education and organization of the sanitarian pro- 
fession for the rendering of services for the solution 



20 



U.S. NAVY MEDICAL NEWS LETTER 



of national, state, and local environmental problems 
and the making of practical contributions in the field of 
public health. 

7. Promote the teaching of environmental health in 
the home and among the youth of the country. Foster 
the presentation of suitable environmental health cur- 
ricula in schools, colleges, and teacher training insti- 
tutions. 

8. Conduct studies and research in various environ- 
mental health problem areas and make findings and 



recommendations available to recognized public health 
officials and voluntary agencies. 

9. Prepare and disseminate environmental health in- 
formation through news releases, brochures, pamphlets, 
and participation in the development of audio-visual 
aids. 

10. Provide leadership for the environmental health 
field so that its members may become more effective 
instruments in the promotion of the purposes and pro- 
grams of public health. 

— PrevMedDiv, BUM ED 




RESERVE SECTION 



CLINICAL CONGRESS OF ABDOMINAL 
SURGEONS 

The annual meeting of the Clinical Congress of 
Abdominal Surgeons will be held at the Jung Hotel, 
New Orleans, Louisiana during the period 20 through 
24 February 1965. A Military Section in conjunction 
with this meeting will be held on the above dates and 
each session will be at least two hours in duration. 

By authority of the Chief of Naval Personnel, one 
retirement point may be credited to eligible Naval 
Reserve Medical Corps officers in attendance. Officers 
are requested to register with the Commandant's Repre- 
sentative in order that attendance may be recorded and 
reported. 



ARMED FORCES INSTITUTE OF 
PATHOLOGY LECTURES 

The annual Armed Forces Institute of Pathology 
Lectures will be held in Washington, D. C. during the 
period 29 March to 2 April 1965. 

By authority of the Chief of Naval Personnel, one 
retirement point may be credited to eligible Naval 
Reserve Medical Corps officers in attendance at each 
session or sessions of two hours duration. Officers are 
requested to register with the Commandant's Rep- 
resentative in order that attendance may be recorded 
and reported. 



CHECK YOUR OWN SERVICE RECORD 

NRA News, XI(J2): 3, December 1964. 

Many Naval Reserve officers who visit Washington, 
D. C. wish to check their records in the Bureau of 

Naval Personnel. 

This can be done by going to Room 3057 in the 
Arlington Navy Annex and showing your ID card. If 
you want to look at a friend's records, you must have 

written authorization to do so. 

Here are a few guidelines to help you in reviewing 
your record: 

First thing to remember is that your official record 
is the property of the Navy Department. As such, 
rearranging the material, adding to it, or taking any- 
thing out, is not permitted. Nor are you permitted to 
make any marks, notations or erasures on any docu- 
ment in your record. 

In fact, Title 1 8 of the U. S. Criminal Code, Section 
2071 states: 

"Whoever willfully and unlawfully conceals, removes, 
multilates, obliterates, or destroys, or attempts to do 
so, or with intent to do so takes and carries away any 
record, proceeding, map, book, paper, document, or 
other thing, filed or deposited with any clerk, or officer 
of any court of the United States, or in any public 
office, or with any judicial or public officer of the 



U.S. NAVY MEDICAL NEWS LETTER 



21 



United States, shall be fined not more than $2,000 or 
imprisoned not more than three years, or both." 

If you find correspondence regarding another officer 
filed in your record, or if you have any questions 
about material that's in your record — or missing from 
it — the receptionist will be able to help you. 

In checking your Fitness Report Jacket, you should 
see whether all your service is covered. If periods of 
reports are not consecutive and a gap exists, call it to 
the attention of the receptionist who will help you 
take steps to bring the record up to date. 

Make sure a photograph in uniform in your present 
grade and taken within the last ten years is in your 
jacket. If not, photographic service is available in the 



Bureau for this purpose. 

When checking your Selection Board Jacket and 
Miscellaneous Correspondence and Orders File, you 
should be sure that they contain all the material perti- 
nent to your naval service and that information, such 
as that on the Record of Emergency Data Form, is 
complete and up to date. And be sure the same is 
true of your Annual Qualification Questionnaire 
(AQQ). 

If you find a cross-reference sheet in your record 
indicating that there is some pertinent classified corre- 
spondence involved and you want to review it, or if 
there's anything you want to check, the receptionist will 
direct you to an appropriate authority. 




MISCELLANY 



DISTRICT BULLETIN 1650 

Subj: Meritorious Mast Awarded to Hospital Corps- 
man First Class Brody 

Hospital Corpsman First Class Bernard Brody, 
3672200/8445/8404, U. S. Navy is commended by 
the Director, First Marine Corps District as follows: 

"It has been brought to my attention that you are a 
dedicated, knowledgeable, and a highly competent Hos- 
pital Corpsman, who administers to the minor aches, 
ailments and injuries of nearly 800 Marine reservists 
at their monthly drills and to 17 regular Marines on a 
full time basis. That your outstanding professional poise 
is accented by rapid application of the proper treat- 
ment to the sick or injured. Your compassionate and 
understanding manner and firm, but gentle, techniques 
personify the image of a man dedicated to the care and 
healing of others. Further, you are responsible for the 
nearly overwhelming administrative burden that the 
proper maintenance of nearly 800 health records can 
cause. The results of the Inspector-General Inspection 
in 1962 and again in 1964, with respect to medical 
matters, were worthy of high praise, as have been the 
annual District Inspections. You have shown an appre- 
ciation for reserve training time and effected liaison with 
U.S. Army Medical authorities to secure the use of a 
gun-type immunization device for mass immunization 
of unit personnel, resulting in time saved by this tech- 
nique being measured, not in minutes, but in hours. 



Also, by your own efforts you have recruited three 
reserve hospital corpsmen and were directly responsible 
for the joining of three Medical Officers. In matters 
of Naval and Naval Reserve administration, policy, or 
custom, you have ensured that the 6th Communication 
Battalion, Force Troops, FMF, USMCR, Naval and 
Marine Corps Reserve Training Center, Fort Schuyler, 
Bronx, New York is always correct and proper. You 
are always willing to share your knowledge and experi- 
ence by conducting first aid and rescue technique in- 
structions for local Boy Scout Troops, the YMCA and 
for a nearby volunteer fire department, using the very 
latest methods. At the request of local police, you 
recently rendered emergency aid to a seriously injured 
child victim of a bus mishap, easing the child's pain, 
calming him, and making him comfortable until an 
ambulance arrived. Your contribution to the Marine 
Corps Reserve "Toys for Tots" drive is praiseworthy by 
voluntarily receiving instruction in the operation of 
heavy trucks, so as to be available for driver service, 
accepting responsibility for sorting and distribution for 
the 1963 "Toys for Tots" drive and by skillfully direct- 
ing the efforts of reserve workers, thereby lending your 
every assistance to ensure a successful program. You 
are a positive indication of the close mutual ties that 
exist between Sailors and Marines and are extremely 
well qualified and deserving of recognition for your 
outstanding efforts and devotion in behalf of our Corps, 
and a credit to the Naval Service. 



22 



U.S. NAVY MEDICAL NEWS LETTER 



SEMINAR ON LEPROSY FOR MILITARY 
DERMATOLOGISTS 



The U.S. Public Health Service under the direction 
of Dr. Edgar B. Johnwick conducted a Seminar on 
Leprosy for Military Dermatologists at the U.S. Public 
Health Service Hospital, Carville, Louisiana from 16-18 
November 1964. There were 10 Navy medical officers 
in attendance: 

CAPT S. L. Moschella, MC USN, USNH Phila., Pa. 

CAPT C. E. Kee, MC USN, USNH San Diego, Calif. 

CDR F. G. Osborne Jr., MC USN, USNH Beaufort, 
South Carolina 

LCDR R. G. Davis MC USN, USNH Great Lakes, 111. 

LCDR G. E. Donnell, MC USN, USNH Bethesda, Md. 

LCDR W. M. Narva, MC USN, USNH San Diego, 
Calif. 

LCDR K. A. Gill, MC USN, USNH Camp Lejeune, 
N. C. 

LCDR C. F. Payne Jr., MC USN, USNH Phila., Pa. 

LT A. Ventzek, USNH Jacksonville, Florida. 

LT D. Chapman, USNH Jacksonville, Florida. 

Capt. R. K. Brooks, D.M.O., 8th Naval District han- 
dled the physical aspects of the program — the total 
transportation, quartering and social activities. 

—Submitted by CAPT S. L. Moschella, MC USN, 
Chief of Dermatology, U. S. Naval Hospital, Phila., 
Pa. 



SON FOLLOWS IN FATHER'S SECOND MOS 

Marine Corps Schools, Quantico, Va., Dec. 16 — 
Consequence of Familiarity — Newly-commissioned Sec- 
ond Lieutenant Gregory M. Donabedian watched as 
his father, Captain George Donabedian, MC USN, 
admired the gold bar placed on his son's uniform. 

LT Donabedian was among 274 members of the 36th 
Officer Candidate Class that were commissioned Dec. 
11, at Marine Corps Schools, Quantico, Va., climaxing 
1 1 weeks of intensive training that began in September. 
To LT Donabedian, becoming a Marine is not a coin- 
cidence. His father, Staff Medical Officer for Head- 
quarters Marine Corps, has served on active duty for 
more than 22 years, all with the Corps, including 
Guadalcanal, Tinian, Okinawa, Japan and Korea. He 
wears four personal combat decorations, along with 
nine campaign and service medals, and has been 
awarded seven personal commendations, including a 
Letter of Appreciation from the President of the Korean 
Medical Association.— By SSGT. R. Jarrell, Jr., Official 
U.S. Marine Corps Release, Informational Services 
Office, Marine Corps Schools, Quantico, Va. 



INDOCTRINATION TOUR FOR INTERNS 

On 12 and 13 November 1964, the combined Med- 
ical and Dental Intern Group from the U.S. Naval 
Hospital, St. Albans, New York, toured various neigh- 
boring activities in an indoctrination tour covering 
various aspects of operational medicine. The tour was 
directed by CAPT D. C. Kent, MC USN, Director of 
Interns, of that hospital. 

The various aspects of submarine and underwater 
medicine were presented by CAPT C. L. Waite and his 
staff of the Submarine Medical Center, New London, 
Connecticut. In addition to a presentation covering 
the broad subject of underwater medicine, the group 
toured the atomic submarine, the USS Dace, the escape 
tank, and viewed the recently completed film on "Oper- 
ation Sea Laboratory." 

CAPT R. H. Lemmon and his staff of ComCruDes 

Lnt discussed the various responsibilities of the Medical 
Officer assigned to shipboard duty, with emphasis on 
the problems thereby encountered. Visits were made 
to a Destroyer and Destroyer Tender to visualize the 
problems of the Medical Officer afloat. 

The War Gaming Department of the U.S. Naval War 
College, Newport, Rhode Island, presented a graphic 
demonstration of the use of the Naval Electronic War- 
fare Simulator, the demonstration included a short 
tactical demonstration of the potentials of the Simulator. 

The tour was completed by a visit to the Station 
Hospital, U.S. Naval Air Station, Quonset Point, Rhode 
Island, as well as a tour through the Overhaul and 
Repair Facility of that activity. The various aspects of 
Aviation Medicine were presented by CAPT M. D. 
Courtney and his staff, including a high altitude simu- 
lation in the low pressure chamber, with demonstration 
of the effects of altitude on the human subject and the 
use of the oxygen demand system of the Navy. In 
addition, the problems of Industrial Medicine in Activi- 
ties such as Quonset Point were discussed. 

The tour was enthusiastically received by all Interns 
who expressed, upon its completion, a development of 
a more oriented attitude toward the problems of Naval 
Medicine. One of the rather surprising facts about 
this tour was the interest and enthusiasm expressed by 
the Line Officers over this type of indoctrination for 
our young medical officers. — Submitted by CO, USNH, 
St. Albans, N. Y. 

NOTICE CONCERNING WEARING OF THE 
UNIFORM 

Members of the Navy Medical Corps attending inter- 
service symposia, courses, classes, etc., are reminded 
that the wearing of our uniform is most desirable. This 
also applies to officers in attendance at other large 
conferences and conventions where attendees are pres- 
ent on orders or by virtue of public funds. During 



U.S. NAVY MEDICAL NEWS LETTER 



23 



certain aspects of said gatherings, the uniform is per- 
haps inappropriate but otherwise the proper wearing 
of the uniform is encouraged. — RADM H. H. Eighmy 
MC USN, Asst Chief for Personnel & Professional 
Operations, BUMED. 

CAPT MONAHAN RECEIVES PLAQUE 
FOR NAVY 
NURSE CORPS 

On 29 October 1964, Captain Dorothy P. Monahan, 
NC, USN represented the Director of the Navy Nurse 
Corps and accepted a plaque from the Philadelphia 
Ladies Auxiliary, Jewish War Veterans of America. 
The plaque was a tribute to the Navy Nurse Corps in 
recognition of dedicated service of all members to 
country and humanity. CAPT Monahan was personally 
honored by being awarded the Distinguished Service 
Award by the Chapel of Four Chaplains. — Nursing 
Division, BUMED. 



FREEDOMS FOUNDATION ANNOUNCES 
LETTER WRITING WINNERS 

Washington, Jan. 3(AFPS) — The top winners from 
each of the services in the 1964 Freedoms Foundation 
Letter Writing Contest will appear in the Presidential 
Inauguration here Jan 20. 

Staff Sergeant Carl E. Carr USAF, Chanute AFB, 
III., has been named overall winner and will receive 
the $ 1 ,000 first prize and a George Washington Honor 
Medal for his letter. 

Other top winners are: LCOL Arnold F. W. Frank 
USA, Camp San Luis Obispo, Calif.; LT John W. 



Margedant USN, NAS, Pensacola, Fla.; Major Robert 
H. Durning USMC, Marine Corps Reserve Training 
Center, Chicago, 111.; and Cadet First Class Joseph R. 
Offutt Jr., USCG Academy, New London, Conn. The 
Army, Navy and Marine Corps winners will each 
receive $100 and a George Washington Honor Medal. 
The Coast Guard winner will receive only the Honor 
Medal. 

Other winners will be announced on Washington's 
Birthday. — AFPS News Release, January 3, 1965. 



ANNUAL AFIP LECTURES 

Washington, D.C. Officials of the Armed Forces Insti- 
tute of Pathology announced today that the Annual 
AFIP Lectures will be held at the Institute March 29- 
April 2, 1965. 

The lectures cover the various organ and body 
systems and will include discussions of the common 
pitfalls in diagnosis, a review of articles published or 
to be published by staff members of the AFIP, new 
advances in histologic techniques, and application of 
newer histochemical, bacteriological, biochemical, im- 
munological and toxicological methods in the daily 
practice of pathology. 

The course will give the busy practicing pathologist 
a concise period of review representing the latest con- 
cepts in pathology. 

Inquiries concerning the course, which is open to 
pathologists, should be sent to: The Director, Armed 
Forces Institute of Pathology, ATTN: Department of 
Pathology, Washington, D.C. 20305.— AFIP Technical 
Liaison Office. 



3Jn iMemoriam 



RADM William T. Lineberry MC USN (Ret) 22 November 

RADM Edward S. Lowe MC USN (Ret) 15 October 

CAPT Howard B. Haisch DC USN 1 8 November 

CAPT James F. Hays MC USN (Ret) 18 December 

CAPT Deane H. Vance MC USN (Ret) 27 November 
CDR Leonard H. Denny MC USN (Ret) 7 December 

CDR Richard W. Hughes, Sr. MC USN (Ret) 13 October 

CDR John H. Jackson MC USNR (Ret) 16 October 

CDR Eugene L. Walter DC USN (Ret) 28 November 

LCDR Marguerite L. Durmwald USN (Ret) 12 November 

LCDR Hayden D. Palmer, Jr. MC USN 21 October 
LT John J. Vizard MSC USN (Ret) 4 November 

ENS Racheal K. Mytenger USN 28 November 

Chief Nurse Ruby Russell NC USN (Ret) 24 November 

CMSW W-2 Ray W. Chiles USNR (Ret) 16 October 

Kathleen Young (Dependent Daughter) 16 October 



1964 
1964 
1964 
1964 
1964 
1964 
1964 
1964 
1964 
1964 
1964 
1964 
1964 
1964 
1964 
1964 



24 



U.S. NAVY MEDICAL NEWS LETTER 



IMPORTANT NOTICE 

U.S. NAVY MEDICAL NEWS LETTER RENEWAL 
REQUEST IS REQUIRED 



Existing regulations require that all Bureau and office mailing lists be checked and circularized once each year 
in order to eliminate erroneous and duplicate mailings. 

It is, therefore, requested that EACH RECIPIENT of the U.S. Navy Medical News Letter (Except U.S. Navy 
and Naval Reserve personnel on ACTIVE DUTY and U.S. Navy Ships and Stations) fill in and forward immedi- 
ately the form appearing below if continuation on the distribution list is desired. However, all recipients, Regu- 
lar and Reserve, are responsible for forwarding changes of address as they occur. 

Failure to reply to the address given below by 15 February 1965 will automatically cause your name to be 
removed from the files. If you are in an Armed Service other than Navy, please state whether Regular, Reserve, 
or Retired. 

Also, PLEASE PRINT LEGIBLY. If names and addresses cannot be deciphered, it is impossible to maintain 
correct listings 

— Editor 



(Detach here) 



Commanding Officer, U.S. Naval Medical School 

National Naval Medical Center (date) 

Bethesda, Md., 20014 

(Attn: Addressograph Office) 



I wish to continue to receive the U. S. Navy Medical News Letter. 



Name 

or 
Activity Ret 

or (Print or type, last name first) (rank, service, corps) 

Civilian Status 



Address 



(number) (street) 
City Zone State 



(SIGNATURE) 
U.S. NAVY MEDICAL NEWS LETTER 25 



DEPARTMENT OF THE NAVY 

U. S. NAVAL MEDICAL SCHOOL 

NATIONAL NAVAL MEDICAL CENTER 

BETHESDA, MARYLAND 20014 






POSTAGE AND FEES PAID 
NAVY DEPARTMENT 



OFFICIAL BUSINESS 



PERMIT NO. 1048 



26 



U.S. NAVY MEDICAL NEWS LETTER